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This review assesses the usefulness surgery for anal fissure, a painful ulcer at the anal opening, by comparing the efficacy of various surgical procedures and how likely they are to result in complications.

Does surgery provide a long term cure for anal fissure? Yes, in better than 90% of patients having recommended operative procedures. Such operations include principally partial division of the anal sphincter, or controlled dilation of the narrowed anal opening. The technique for cutting the muscle has been refined in recent years and appears to improve cure and diminish the risk of bowel control problems. The method of achieving controlled anal dilation needs further investigation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Non surgical therapy for anal fissure.

Anal fissure is a painful ulcer usually occurring in the posterior midline of the skin just outside the entry to the rectum. Its persistence is due to spasm of the internal sphincter muscle. The typical pain of this condition is pain on moving one's bowels that persists for some time afterward. Relief with healing of chronic fissures until very recently has been achieved by surgical procedures aimed at ablation of the sphincter spasm. Because of the risk of incontinence resulting from surgery, medical alternatives for surgery have been sought. Among the older medications, bran is effective in preventing recurrence of acute fissure. Local application of muscle relaxing therapy is effective in healing chronic anal fissure, though not as well as surgery, and with considerable risk of adverse events during therapy. There is a Cochrane review related to this review dealing only with surgical procedures.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Systematic Reviews in PubMed

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