The comparison between the medical and the surgical management of chronic anal fissures

Abstract

Introduction. Anal fissures can be defined as a tear or a break in the anoderm. Acute fissures do not exceed a 6 week-duration and can be seen as a simple tear in the anoderm along with edema, whereas chronic fissures are longer than 6 weeks. Aim. To compare the efficacy of the medical and surgical options for the treatment of chronic anal fissures and to recommend the appropriate option in terms of their symptomatic relief, healing of fissures and long-term effectiveness. Materials & Methods. A prospective observational study was conducted for a period of 2 years, that is, from October 2018 to October 2020, including a follow-up period of 2 months. A total of 72 patients with chronic anal fissures were included in the study and randomized into two groups, represented by the medical management group and the surgical management group (Lateral Internal Sphincterotomy (LIS)). Results. In the case of the 36 patients with CAF (chronic anal fissure) who underwent surgical management, all 36 (100%) patients had optimal healing of the fissure at 6 weeks. In the case of the 36 patients with CAF who underwent medical management, only 32 (89%) patients had optimal healing of the fissure at 6 weeks, whereas 4 patients failed to heal even after 2 months. Conclusions. Surgical management is the preferable method for chronic anal fissures in comparison to medical management. But the medical management has a role in acting as a bridge to surgical management in patients who are not fit for surgery or do not perceive surgery as an option at the time.