ObjectiveClinical trials, meta-analyses and clinical guidelines have helped to determine the best approach to treating anal fissures, but evaluations of clinical practices are lacking. The goal of this study was to describe the management of anal fissures, paying particular attention to chronicity and surgical procedures.MethodsIn May 2006, a questionnaire was mailed to 3,350 French gastroenterologists and digestive surgeons in order to assess their management of patients with anal fissure over the previous month.ResultsAs of October 2006, 378 physicians (11%) returned the questionnaire, resulting in data for a pool of 2,483 patients (mean: 6.6 patients/month/physician). The symptoms recorded were pain (100%), bleeding (90%), constipation (57%) and pruritus (26%). Visual inspection was sufficient for 25% of the physicians to reach a diagnosis, while an additional 60% required digital rectal examination or anoscopy. Chronic fissures occurred in 1,081 patients (44%). Chronicity was defined by > 6-month duration, presence of a fibrous tags, elevated fissure margins, sentinel piles, and visible sphincter fibres for 39, 64, 44, 35 and 32% of the physicians, respectively.The proposed treatments are as follows: Two out of 3 surgical procedures consisted of fissurectomy without either sphincterotomy or anal dilation (9/10 fissurectomies included mucosal anoplasty).ConclusionThe diagnostic criteria for chronic anal fissures were most often based on clinical presentation. The management of acute and chronic fissures mostly differed in terms of the indication for surgery. Fissurectomy with mucosal anoplasty without sphincterotomy is the most widely used technique.