Chronic anal fissure (CAF) is a painful condition occurring in the anoderm. The optimal algorithm of therapy for CAF is still being developed. Chemical sphincterotomy (CS) is safe and easy to use, with rapid relief of pain, mild side-effects, which avoids the risk of surgery or anesthesia. The aim of the study was a review of medical randomised studies of therapy with a type of CS - botulinum toxin (BTX) for CAF and an assessment of its efficacy comparing it with surgery. It showed that although Lateral internal sphincterotomy (LIS) associates with a high rate of minor anal incontinence as compared to BTX, it is a statistically more effective therapy for CAF than BTX. A rate of CAF recurrence was also significantly less in the group of patients treated with LIS. As long as the patient is willing to accept a risk of faecal incontinence, we find grounds for LIS as the first-line treatment for CAF. However, it is prudent and favorable to the patient to initially consider chemical sphincterotomy when the diagnosis of fissure is made, because we cannot determine, if the patient who has a positive response on CS, would not potentially develop a severe complication following LIS.
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