Innovations in chronic anal fissure treatment:A systematic review

摘要

A chronic anal fissure is a common perianal condition.This review aims to evaluate both existing and new therapies in the treatment of chronic fissures.Pharmacological therapies such as glyceryl trinitrate(GTN),Diltiazem ointment and Botulinum toxin provide a relatively non-invasive option,but with higher recurrence rates.Lateral sphincterotomy remains the gold standard for treatment.Anal dilatation has no role in treatment.New therapies include perineal support devices,Gonyautoxin injection,fissurectomy,fissurotomy,sphincterolysis,and flap procedures.Further research is required comparing these new therapies with existing established therapies.This paper recommends initial pharmacological therapy with GTN or Diltiazem ointment with Botulinum toxin as a possible second line pharmacological therapy.Perineal support may offer a new dimension in improving healing rates.Lateral sphincterotomy should be offered if pharmacological therapy fails.New therapies are not suitable as first line treatments,though they can be considered if conventional treatment fails.