A review of recent advances in the surgical management of anal fissures

Abstract

An anal fissure is a rupture or lesion in the anal canal's lining below the mucocutaneous junction or dentate line. It is a painful condition that can last for up to two hours during and after defecation. The present literature review is aimed at outlining the clinical signs and symptoms, etiopathogenesis, clinical evaluation, and surgical management of anal fissures with a brief discussion on laser-assisted surgeries. This literature review has been compiled to revisit the different treatment modalities of anal fissures based on the recent updates in the literature. PubMed and ScienceDirect databases were used for the literature search of this review. Based on the literature review surgical interventions are necessary when the conventional pharmacological treatment fails to cure the disease. There are varying outcomes based on the type of surgery with respect to healing rates, recurrence, and incontinence. However, the outcomes of surgery may vary from patient to patient. Various studies have shown that lateral internal sphincterotomy is currently considered the most effective surgical treatment for anal fissures. Surgeons may choose to use either the closed or open method for this procedure. Using lasers for sphincterotomy can help to minimize bleeding and postoperative pain. Despite numerous clinical practice guidelines and systematic reviews, there is still debate over the ideal anal fissure treatment. Surgical treatments discussed in this review have varying advantages and the surgeon is the right person to decide which procedure is suitable for the patient.