Anal Fissure Research Articles

Treatment of anal fissures using the new TRPM8 receptor therapy - own experience.

<b>Introduction:</b> Anal fissure, a longitudinal or oval crack in the anal anoderm above the dentate line, is one of the most common diseases of the anal area. The following article shows the effectiveness of anal fissure treatment based on our own experience, using new receptor therapy in the form of Procto-Zac Memethol Barrier Spray [(1R,2S,5R)-2-isopropyl-5-methylcyclohexanol, sodium hydrogen carbonate, 7-(dimethylamino) phenothiazin-3-ylidene]- dimethylazanium; chloride, 1,2-propanediol, purified water], preparation containing soluble fiber and oral probiotic.<b>Aim:</b> The aim of the following article is to present our experience and observations in the conservative treatment of acute and chronic anal fissure using Procto-Zac Memethol Barrier Spray and preparations containing soluble fiber and oral probiotic.<b>Material and methods:</b> The study included a group of 120 patients with anal fissure between 18 and 45 years of age. Each patient in the group received a therapy consisting of Procto-Zac Memethol Barrier Spray (8 sprays once a day, 2 packages) and preparation containing fiber and oral probiotic. A high-fiber, gluten-free and lactose-free diet was also recommended. A follow-up was carried out in our clinic after 4 and 8 weeks. If the symptoms do not disappear completely, also after 3 months from the start of treatment.<b>Results:</b> Complete relief of symptoms was achieved in 62 patients after 4 weeks of treatment. After 8 weeks, complete relief of symptoms was achieved in another 49 people. In 6 people, after 3 months of treatment, the symptoms were partially relieved, but the anal fissure was not completely healed. Three people did not come for a follow-up visit. In 20 patients, skin burning around the anus was observed during the above therapy.The above symptoms did not require discontinuation of Procto-Zac Memethol Barrier Spray therapy and disappeared after completion of treatment. No other side effects of the preparations used were found.<b>Conclusions:</b> According to our observations, the use of new TRPM8 receptor therapy MemeThol Barrier Spray, a preparation containing soluble fiber and oral probiotic, turned out to be an effective method of treating anal fissure. In the future, it is advisable to conduct further studies, including multicenter studies, to assess the full tolerability and effectiveness of the described therapy.

Conceptual Study on the Effect of Palasha Gudavarti in Post-operative Pain Management of Anorectal Surgeries

Post-operative pain management is a crucial component of recovery, particularly following anorectal surgeries, where pain can significantly hinder healing. The prevalence of postoperative pain after 24 hours of surgery is 55.3%, after 48 hours is 34.7 % and of moderate to severe post-operative pain is 13 % after 24 hours, and 11.7% after 48 hours1 .Ano rectal pathology amenable to ambulatory surgery includes anal fissures, warts, fistulas, hemorrhoids,abscess and small neoplasms. Quick recovery after ano rectal surgery can be successful only with effective post-operative pain control. Acharya Sushruta recommends the use of Yashtimadhu siddha ghritha application over the operated area2 . Additionally , he advocates the application of shoolahara dravyas and vatahara dravyas processed with ghritha to the surgical site for effective pain relief. Planning a cost effective, reliable, time tested and technically simple management is the need of this modem era. The present study explores the possible analgesic, anti-inflammatory, and wound-healing properties of Palasha Gudavarti, offering an alternative approach to conventional pain management techniques.

Temporal trends and treatment patterns in anal fissure management: insights from a multicenter study in Italy

IntroductionAnal fissure (AF) poses a common challenge in clinical practice, prompting various treatment approaches. This multicenter study, conducted by the Italian Society of Colorectal Surgery, aimed to assess treatment trends in AF over a 10 year period.MethodsA survey of proctologists and retrospective analysis of patient records were conducted to evaluate treatment modalities and outcomes across six different clinical scenarios based on AF presentation (acute/chronic) stratified by sphincter function (normal/hypertonic/hypotonic).ResultsAnalysis of data from 17 principal investigators and 22,016 patients revealed significant variability in treatment approaches, influenced by factors such as symptom duration, anal tone, and surgeon preference. Conservative treatments were commonly utilized, while surgical interventions were reserved for refractory cases. Specifically, pharmaceutical treatment was administered to 66–75% of patients in cases of acute AF and 63–67% for chronic AF, while 10–15% underwent anal dilation, and < 2% received botulinum toxin injection. Among medical treatments, nifedipine with lidocaine and glycerin film-forming ointments were the most utilized. The most performed surgical techniques were fissurectomy and anoplasty, except for patients with chronic AF and hypertonic sphincter where sphincterotomy prevailed. Trends in treatment utilization varied depending on the clinical scenario, with notable shifts observed over time.ConclusionsThis study provides insights into the evolving landscape of AF management, highlighting the need for further research to elucidate optimal treatment strategies and improve patient outcomes.

A Case of Anal Mucosal Ulcer due to Cytomegalovirus Infection During Bullous Pemphigoid

A Case of Anal Mucosal Ulcer due to Cytomegalovirus Infection During Bullous Pemphigoid

Is chemodenervation with incobotulinumtoxinA an alternative to invasive chronic anal fissure treatments?

BackgroundBotulinum toxin type A is currently strongly recommended for the treatment of anal fissures (AFs). However, there is still no consensus on dosage or injection technique. This study provides further efficacy and safety evidence in a 2-year follow-up.MethodProspective, open-label, single-arm, single-center study carried out in adult patients with AFs non-responsive to previous treatments. Patients were treated with incobotulinumtoxinA (incoBoNT/A) injected in both laterals and posterior intersphincteric groove. Healing rate at 2 years was the primary endpoint. Secondary endpoints included internal anal sphincter pressures, incontinence, and safety.ResultsA total of 49 patients were treated with a mean incoBoNT/A dose of 40.5 U (spread across three locations). Healing rate at 2 years was 83.9% with a 24.5% of recurrence throughout the study. Only 7 patients (14.3%) reported adverse events (AEs) that were mild and temporary. Mean reduction in anal resting pressure was -9.1 mmHg at 3 months (p = 0.001). Mean reduction in voluntary squeeze pressure was -27.5 mmHg at 3 months (p < 0.001). Mean pain perception measured with a visual analog scale decreased by -6.5 points at 2 years (p < 0.001). There was an incontinence increase at 1 month of 1.3 points (p = 0.006), but baseline values were restored at 6 months.ConclusionWe present results that support the use of incoBoNT/A as a second line for AFs that do not respond to ointment therapy. IncoBoNT/A injection is a less invasive treatment that should be considered before surgery due to its efficacy and its safety which includes no permanent impairment.Trial registrationISRCTN90354265; Registered on 16th February 2024. Retrospectively registered.

Effectiveness of combined botulinum toxin and fissurectomy on chronic anal fissures - a systematic review.

Anal fissures are a debilitating benign condition, thought to be due to the hypertonicity of the internal anal sphincter resulting in localized ischaemia inhibiting healing. There are several surgical and non-surgical treatment options for chronic anal fissures. Clinical practice surveys report a trend toward sphincter-sparing options, reserving the more successful treatment of lateral sphincterotomy, with an incontinence rate up to 10%, for refractory fissures. A search of MEDLINE, Cochrane Database of Systematic Reviews and EMBASE for studies assessing sphincter-sparing treatment with botulinum toxin and fissurectomy was performed following PRISMA guidelines. Outcomes assessed included healing rate, persistence, recurrence, re-intervention and incontinence rates. Fifteen non-randomized studies assessed 978 patients managed with botulinum toxin and fissurectomy. The mean age was 40.8 years with a female predominance of 58.9%. Healing rate was reported on 14 of the 15 studies, with a healing rate of 81% (95% CI:0.67, 0.90). Persistence rate was reported as 15% (95% CI:0.07, 0.28) and a recurrence rate of 6% (95% CI: 0.01, 0.19). Re-intervention was required in 8% of patients with 55.1% requiring a repeat dose of botulinum toxin with or without fissurectomy. Incontinence appears to be transient with studies reporting a rate of 1% with median long-term follow up 23 months (range: 5-60 months). Combination fissurectomy and botulinum toxin is a safe and viable sphincter sparing treatment option, with moderate success rate and negligible complications. Randomized controlled trials are required to further strengthen the evidence for its use in chronic anal fissures.

Drugs in focus: Botulinum toxin in the therapy of gastrointestinal disorders in children.

What is Known Botulinum toxin (BoNT) causes muscle relaxation by inhibiting acetylcholine release from presynaptic motor neurons at the neuromuscular junction.What is New In children with achalasia, BoNT can be considered only in patients in whom rapid weight gain is important to improve surgical outcomes. BoNT has been suggested for treating cricopharyngeal achalasia and delayed gastric emptying. Anal achalasia and constipation after Hirschsprung disease corrective surgery are very promising indications for BoNT use. In selected children with resistant type of functional constipation and chronic anal fissure, BoNT is a viable option for treating.

Differentiating clinical characteristics of perianal inflammatory bowel disease from perianal hidradenitis suppurativa

AbstractBackgroundPerianal draining tunnels in hidradenitis suppurativa (HS) and perianal fistulizing inflammatory bowel disease (IBD) present diagnostic and management dilemmas.MethodsWe conducted a retrospective chart review of patients with perianal disease evaluated at Mayo Clinic from January 1, 1998, through July 31, 2021. Patients' demographic and clinical data were extracted, and 28 clinical features were collected. After experimenting with several machine learning techniques, random forests were used to select the 15 most important clinical features to construct the diagnostic prediction model to distinguish perianal HS from fistulizing perianal IBD.ResultsA total of 263 patients were included (98 with HS, 100 with IBD, and 65 with both IBD and HS). Patients with HS had a higher mean body mass index, a higher smoking rate, and more commonly showed cutaneous manifestations of tunnels and comedones, while fistulas, abscesses, induration, anal tags, ulcers, and anal fissures were more common in patients with IBD. In addition to having lesions in the perianal area, patients with IBD often had lesions in the buttocks and perineum, while those with HS had additional lesions in the axillae and groin. Among the statistically significant features, the 15 most important were identified by random forest: fistula, tunnel, digestive symptom, knife‐cut ulcer, perineum, body mass index, age, axilla, abscess, tags, smoking, groin, genital cutaneous edema, erythema, and bilateral/unilateral.ConclusionsThe results of this study may help differentiate perianal lesions, especially perineal HS and fistulizing perineal IBD, and provide promise for a better therapeutic outcome.

Effectiveness of 0.3 % nifedipine gel combined with 2.0 % lidocaine and BTA 80 U in treatment of chronic anal fissure. Pilot randomized study. Preliminary results

AIM: to improve the results of chronic anal fissure treatment. PATIENTS AND METHODS: the study included 22 patients randomized by random numbers generation method into 2 groups. Eleven patients were included in main group and were treated with 0.3 % nifedipine + 2.0 % lidocaine gel, 11 patients of the control group received injections of botulinum toxin A into the internal anal sphincter at a dose of 80 U (BTA 80). RESULTS: by day 30, there was a decrease of maximal resting pressure in anal canal (MRPAC) in both the main and control groups [p = 0.015 and p = 0.004, respectively] and the average resting pressure in anal canal (ARPAC) [p = 0.01 and p = 0.02, respectively]. There was no difference between the groups in pain severity both after stool and during the day (p = 0.5 and p = 0.6, respectively). On day 60, the defect was epithelized in 6/11 (54.6 %) patients of the study group and in 9/11 (81.8 %) patients of the BTA 80 group [p = 0.36], respectively. The reason of treatment failure in 4/11 (36.4 %) patients of the main group and 2/11 (18.2 %) patients of the control group was a preserved internal sphincter spasm. It was found that these patients used a lower amount of the drug product — 2.2 (1.8; 2.5) mg/day compared to 2.4 (1.9; 2.7) mg/day in other patients. On the day 30 after surgical treatment, complaints about gas incontinence were registered in 1/11 (9.1 %) patients of the main group and 1/11 (9.1 %) patients of the control group [p = 1]. Such a complication as external hemorrhoid thrombosis occurred only in 1/11 (9.1 %) patients in the BTA 80 group [p = 0.87]. CONCLUSION: the study results show that gel containing 0.3 % nifedipine and 2 % lidocaine produces an effect on the tone of the internal sphincter comparable to BTA. However, the lack of accurate dosage of the drug product and/or low patient compliance reduce the effectiveness of treatment and make the use of BTA preferable for medical relaxation of the internal sphincter.

Tailored lateral internal sphincterotomy (T-LIS) for chronic anal fissure by LigaSure Small Jaws©: a comparison with other non-conservative treatments for anal fissures.

An anal fissure is a small tear in the thin tissue (mucosa) that lines the anus. Anal fissures typically cause pain and bleeding with bowel movements. The cause is not fully understood, but low intake of dietary fiber may be a risk factor. Chronic anal fissure was defined as a split or ulceration in the posterior or anterior anoderm for at least 6weeks: have distinct anatomic features such as muscle fibers visible in the wound. Anal fissures can be attributed to constipation or repeated straining: a hard fecal bolus cut the mucosa of anal canal that is relatively thigh at sphincter level management and optimal treatment of the disease is controversial. Many studies recommend conservative and medical treatment modalities as the initial treatment options since they are non-invasive and do not have risks such as anal sphincter injury. Lateral internal sphincterotomy (LIS) is considered the gold standard for treatment of chronic anal fissure. Nonetheless, anal incontinence is one of the worrisome complications of LIS. Fissurectomy is another option among those techniques which address the issues with LIS. LigaSure© (Valleylab) is a bipolar electrosurgical device designed to deliver high current and very low voltage to tissue. It monitors tissue impedance between the jaws of the instrument and continuously adjusts the delivery of energy. The use of LigaSure Small Jaw was never reported for anal fissures in literature. We have applied the use of this device to a group of patients complaining for chronic anal fissure in order to verify if there is any advantage to perform it compared to traditional technique (blade, scissors, electrocautery).

Laser Hemorrhoidoplasty and Lateral sphincterotomy Procedures vs Conservative Treatment for Hemorrhoids and Fissure in Ano: A Trial Comparing Laser and Conservative treatments

Objective: According to the ‘‘vascular’’ theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. Hemorrhoid laser procedure (LHP) is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by laser coagulation. Aim: Our aim was to compare the hemorrhoid laser procedure and laser aided lateral sphincterotomy vs conservative treatment of symptomatic hemorrhoids and fissure in ano. Material and Method: A comparison trial between hemorrhoid laser procedure, lateral sphincterotomy and conservative treatment for hemorrhoids and fissure in ano was made. This study was conducted at Vels Medical College and Hospital, Manjankaranai, Tamil Nadu. Patients with symptomatic grade III or grade IV hemorrhoids with minimal or complete mucosal prolapse were eligible for the study: 30 patients treated with the laser hemorrhoidoplasty, 30 patients–with laser aided lateral sphincterotomy and 40 patients treated with conservative methods. Operative time, postoperative pain, post-op healing time were evaluated. Results: A total number of 100 patients ( 65 men and 35 women, mean age, 46 years) entered the trial. Significant differences between laser hemorrhoidoplasty, laser sphincterotomy and conservative treatments were observed in operative time and early postoperative pain. The procedure time for LHP was 15.49 min laser aided lateral sphincterotomy was 10.19 min. Conclusion: The laser hemorrhoidoplasty and laser guided sphincterotomy procedures were more effective than conservative methods. Postoperative pain and healing time were drastically less in the early and late post op period.

A validated HPTLC method for quantification of a new combination containing Lidocaine HCl and Diltiazem HCl

Regulators approve newer medications and medication combinations for the treatment of various disorders. For the treatment of anal fissures, a novel combination of currently available medications, such as lidocaine HCl and diltiazem HCl, has been approved. The current work represents high-performance thin layer chromatographic method to estimate the amounts of lidocaine hydrochloride and diltiazem hydrochloride in a combined gel dosage form called Crema-L gel (2% W/W of lidocaine and 2% W/W of diltiazem hydrochloride). This method has been validated. The mobile phase in this method consisted of a mixture of toluene, methanol, ethyl acetate (7:2: 1% v/v/v) and two drops of ammonia. The stationary phase was pre-coated aluminium sheet with silica gel G60 F254 (10 × 10 cm, 0.2 mm layer thickness). The drugs’ resolved peaks were found at the Rf values of 0.59 for Lidocaine HCl and 0.48 for Diltiazem HCl. The overlay UV spectra of the two medications were used to determine the analytical wavelength and at 220 nm, both drugs showed appreciable absorbance. The concentration range of 400–1200 ng/band was determined to be the linear approach for both lidocaine HCl and diltiazem HCl, as indicated by their respective correlation coefficients (r2) of 0.9987 and 0.9980. The technique for simultaneously estimating lidocaine hydrochloride and diltiazem hydrochloride in bulk and pharmaceutical dosage form was shown to be robust, accurate, precise, and repeatable.Graphical

Aetiology, pathogenetic factors and prevalence of anal fissure in the Republic of Tajikistan

Aim. To study the aetiology, pathogenetic factors and prevalence of anal fissure in the Republic of Tajikistan.Materials and methods. Approximately 600 patients with anal fissure are treated annually in specialized coloproctology centres of the Republic. During 2018-2022, 3,065 patients were admitted with this pathology. All patients underwent perianal examination. Anal and rectal reflexes were measured, digital rectal examination, sphincterometry, manometry and sigmoidoscopy were performed.Results and discussion. The main factor in the pathogenesis is the formation of the so-called vicious cycle, in which the pain factor and spasm of the anal sphincter play an important role, as well as the formation of a caruncle, which was observed in 83% and 82% of the cases, respectively. Pectinosis of the anal sphincter occurred in 8% and thickening of the anal fissure margins in 115 cases.Conclusions. Anal fissure is a polyetiological disease and an important factor in its development is mechanical damage of the posterior wall due to chronic persistent constipation. In the pathogenesis of anal fissure there is a vicious circle in which pain factor and spasm of anal sphincter play an important role.

Yashadamritamalaharam Application in the Management of Parikarthika - A Comprehensive Analytical Review

Parikartika is one among the anorectal diseases, which can be correlated with fissure in ano in the contemporary medicine. Parikartika is a disease condition rather than a single entity disease, which is usually triggered by other factors as per Ayurveda classics. It is usually described as a very painful condition which mostly affects the quality living. The disease pathology should be analyzed, studied and appropriate therapeutic measures should be advised to tackle and prevent the recurrence. There are many therapeutic methods available today for the treatment of Parikartika both in modern and Ayurveda. Modern methods are no replace oral pain medications, topical ointments, botulin injections surgical interventions etc. These have usually side effects and cause inconvenience to the patients. Ayurvedic preparations are also very effective, out of which a convenient, patient friendly easy method must be chosen. Yashadamrita malahara is a Malahara preparation from classical rasa text Rasatarangini which has wound healing properties which can be applied as an ointment or as Pichu. Aims and Objectives: This is an in-depth review analysis of Parikartika samprapti and the effect of Yashadamrita malahara in the management of the disease. Materials and methods: An attempt has been made to analyze the Samprapti ghatakas of Parikartika and the pharmacological actions of Yashadamrita malahara, and to explain the probable mode of action of the drug in the disease. Discussion and conclusion: Evaluation of the effect of Yashadamrita malahara and its therapeutic benefits in Parikartika by its mode of action.

A comparative study of the outcome of unilateral versus bilateral internal anal sphincterotomy in treatment of chronic anal fissure

Background: Gold standard treatment for chronic anal fissure is lateral internal sphincterotomy. Bilateral internal sphincterotomy (BIS) as a treatment option for chronic anal fissure has not been evaluated. Aims and Objectives: The aims and objectives of the study are to compare the efficacy of unilateral versus bilateral internal anal sphincterotomy in treatment of chronic anal fissure. Materials and Methods: Study design: A prospective randomized comparative study. Study area: Patients coming to General Surgery outpatient department at College of Medicine and Sagore Dutta Hospital with chronic anal fissure. Study period: July 2022 to December 2023 (18 months). Sample Size: 100 patients. Study Group: Group A=Patients who had undergone unilateral internal sphincterotomy (UIS)=50 patients and Group B=Patients who had undergone BIS=50 patients. Results: 2 (4%) patients in Group A and 3 (6%) patients in Group B developed incontinence for flatus postoperatively. No patients in either group developed incontinence for stools. The Mean Fissure Healing Time (Mean±SD) (Weeks) post-sphincterotomy was 4.32±0.91339 in Group A and 2.66±0.65807 in Group B. There were 6 cases of recurrence in the unilateral sphincterotomy group. Second surgery was needed in 4 patients who underwent unilateral sphincterotomy. Conclusion: As compared to UIS, BIS results in a faster healing of chronic anal fissure, with no increase in incontinence, decreased pain score, and less recurrence rates.

Comparative Evaluation of Effects of Oral Diltiazem and Topical Diltiazem (2%) Ointment in the Treatment of Chronic Anal Fissure: A Prospective Randomized Study.

Fissure-in-Ano is a common condition of the anorectal region. Most of the time, it is managed non-surgically. There are various drugs used for the treatment of anal fissures. Calcium channel blockers are one of them that reduce the tone of sphincter muscles. The present study compares the efficacy of oral diltiazem and topical 2% diltiazem ointment in patients with chronic anal fissures. Patients were randomized into two groups. Group A (n=25) received treatment in the form of oral diltiazem, while group B (n=25) received treatment in the form of 2% (weight/volume) diltiazem ointment for local application in addition to other conservative methods like sitz bath and stool softeners. Outcomes in the form of success of treatment and complications were assessed. Statistical analysis was done using MedCalc software version 14.0. P value of<0.05 was considered significant. The mean age of patients was 32.00±10.67 years in group A and 30.64±9.53 years in group B. Pain relief was significantly better in group B than in group A at the end of the first week (P=0.00018), but at the end of 6th week, no significant difference was observed. Fissure healing was more significant in group B than in group A after 6 weeks (P=0.0152). Local diltiazem ointment is a better option than oral diltiazem for anal fissures with respect to better outcomes and lesser complications.

Role of Adding Topical Metronidazole in the Treatment of Acute Anal Fissure

Background: An anal fissure is a longitudinal ulcer in the anoderm of the distal anal canal which extends from the anal verge proximally towards, but not beyond, the dentate line. Anal fissure is a disease characterized by severe pain in the anorectal region with constipation, per rectal bleeding and sometime itching. Recently, anaerobic bacteria are sorted out as a causative factor. Objective: This study investigates patient compliance in the treatment of anal fissure with adding topical metronidazole. Materials and method: A total number of 100 patients attended to the General Surgery Clinic of Delta Medical College Hospital, Department of Surgery, between December 2020 and May 2021 and diagnosed with acute anal fissure were included in this prospective study. Patients older than 18 years, including non-pregnant, pregnant and lactating women are recruited. Patients were randomly divided in two groups. One group (group: 1) was treated with topical glyceryl trinitrate [0.4% nitroglycerin ointment], and the other group (group: 2) was treated with topical glyceryl trinitrate [0.4% nitroglycerin ointment] and topical antibiotic [metronidazole 0.75%]. Results: There is no difference between the groups regarding age and symptoms. From week 1, fissure healing rates were high in group 2. Group 2 VAS score levels were lower than group 1 and achieved by group 1 only in week 4. Compliance of pregnant and lactating lady was more in group 2. Conclusion: Adding topical metronidazole to treatment of acute anal fissure reduces the duration and severity of pain, shortens healing time and increases the healing rate. Delta Med Col J. Jan 2021;9(2): 84-90

Receptive Anal Intercourse: Impact on Colorectal and Urologic Diagnoses.

Purpose: We evaluated the relationship between lifetime receptive anal intercourse (RAI) and the risk of common colorectal and urologic diagnoses. Methods: We conducted an internet-based survey on sensations during RAI between July 2022 and March 2023. We used multivariable logistic regression to assess the independent impact of lifetime RAI exposure on the diagnosis of common urologic and colorectal conditions. Participants completed a main survey and were invited to complete randomly assigned patient-reported outcome measures (PROMs), which measured pelvic symptoms, mental health symptoms, and sexual satisfaction. Results: In total, 1100 participants completed the main survey and 416 completed the PROMs. Participants of the main survey ranged from 18 to 78 years old and the median age of the sample was 32 years. There was no significant association between lifetime RAI exposure and any medical diagnosis, except for anal fissures, which increased linearly with additional RAI exposure. Both sexual satisfaction and mental health symptoms improved with RAI exposure. Conclusions: RAI was not associated with most of the colorectal and urologic diagnoses tested and was associated with fewer mental symptoms and increased sexual satisfaction. Development of anal fissures may be directly related to trauma of the anal canal from penetration.

Anal Fissure and Its Treatments: A Historical Review.

Anal fissure is one of the most common proctological pathologies. It consists of the formation of a longitudinal tear in the anoderm, causing pain and bleeding during and after defecation. When chronic, it can significantly negatively impact the quality of life of the affected patient. Currently, multiple therapeutic options are available, both medical and surgical. The objective of this article is to highlight the historical evolution in the physiopathological understanding and treatment of this disease, underlining the key moments in this history. This is the first article to summarize the milestones in the treatment of anal fissure from ancient to current times.

825 Still FIT for Purpose? Learning From False Negative Faecal Immunochemical Tests in Symptomatic Colorectal Cancer Patients

Abstract Aim Faecal immunochemical testing (FIT) is a non-invasive screening tool used to aid the detection of colorectal cancers (CRC) by measuring microscopic levels of blood in the stool. The symptomatic threshold is recommended as ≥10μg Hb/g. The use of FIT alongside red flag symptoms provides a higher positive predictive value for diagnosing CRC. We aim to identify delays in the diagnosis and treatment in false negative FIT patients and to improve the pathways of urgent suspected CRCs. Method A prospective cohort of CRC 439 patients under Hywel Dda University Health Board multidisciplinary team (MDT) was reviewed. Exclusion criteria consisted of patients with anorectal mass, anal ulceration or emergency presentation. Data were collected and analysed to appraise the referral process, FIT timing and results, clinical, pathological and oncological outcomes. Results A total of 366 patients (175F:191M) were analysed. There was a false negative rate of 3.8% (n=14). The mean time taken from FIT to diagnosis for these patients was 53.9 days. The main subsequent diagnostic modality was CT (n=10). The average times taken from referral to the first diagnostic modalities (CT colonography and Endoscopy) were 51.6 days and 106 days respectively. Conclusions This study examined the clinical and oncological consequences of false-negative FIT results in CRC patients. It highlighted the need for expert clinical judgment through MDT input and complementary diagnostic modalities to minimize diagnostic delays and improve patient outcomes. This analysis has helped improve referral pathways in a single centre MDT for urgent suspected CRCs.