Surgeons' practice and preferences for the anal fissure treatment: results from an international survey

Updates Surg. 2023 Dec;75(8):2279-2290. doi: 10.1007/s13304-023-01661-x. Epub 2023 Oct 8.

Abstract

The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons' practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants' demographics and, 27 questions about their clinical practice. Based on the specialty (general surgeon and colorectal surgeon), obtained data were divided and compared between two groups. Five-hundred surgeons were included (321 general and 179 colorectal surgeons). For both groups, duration of symptoms for at least 6 weeks is the most important factor for AF diagnosis (30.6%). Type of AF (acute vs chronic) is the most important factor which guide the therapeutic plan (44.4%). The first treatment of choice for acute AF is ointment application for both groups (59.6%). For the treatment of chronic AF, this data is confirmed by colorectal surgeons (57%), but not by the general surgeons who prefer the lateral internal sphincterotomy (LIS) (31.8%) (p = 0.0001). Botulin toxin injection is most performed by colorectal surgeons (58.7%) in comparison to general surgeons (20.9%) (p = 0.0001). Anal flap is mostly performed by colorectal surgeons (37.4%) in comparison to general surgeons (28.3%) (p = 0.0001). Fissurectomy alone is statistically significantly most performed by general surgeons in comparison to colorectal surgeons (57.9% and 43.6%, respectively) (p = 0.0020). This analysis provides useful information about the clinical practice for the management of a debated topic such as AF treatment. Shared guidelines and consensus especially focused on operative management are required to standardize the treatment and to improve postoperative results.

Keywords: Acute anal fissure; Anal fissure treatment; Chronic anal fissure; International survey.

MeSH terms

  • Anal Canal / surgery
  • Botulinum Toxins, Type A*
  • Chronic Disease
  • Colorectal Neoplasms* / drug therapy
  • Fissure in Ano* / drug therapy
  • Fissure in Ano* / surgery
  • Humans
  • Neuromuscular Agents* / therapeutic use
  • Surgeons*
  • Treatment Outcome

Substances

  • Botulinum Toxins, Type A
  • Neuromuscular Agents