Botox and CCBs were equivalent to GTN in efficacy with fewer adverse events .
No medical therapy came close to the efficacy of surgical sphincterotomy , though none in these RCTs was associated with the risk of incontinence .
Medical therapy for chronic anal fissure , acute fissure and fissure in children may be applied with a chance of cure that is marginally better than placebo , and , for chronic fissure in adults , far less effective than surgery
BACKGROUND Because of the disability associated with surgery for anal fissure and the risk of incontinence , medical alternatives for surgery have been sought .
Most recently , pharmacologic methods that relax the anal smooth muscle , to accomplish reversibly what occurs in surgery , have been used to obtain fissure healing .
OBJECTIVES To assess the efficacy and morbidity of various medical therapies for anal fissure .
Surgical versus chemical (botulinum toxin) sphincterotomy for chronic anal fissure: long-term results of a prospective randomized clinical and manometric study.
BACKGROUND The aim of this prospect i ve r and omized trial was to compare the effectiveness and morbidity of surgical versus chemical sphincterotomy in the treatment of chronic anal fissure after a 3-year follow-up . METHODS Eighty patients with chronic anal fissure were treated by whether open lateral internal sphincterotomy ( group 1 ) or chemical sphincterotomy with 25 U botulinum toxin injected into the internal sphincter ( group 2 ) . Clinical and manometric results were analyzed . RESULTS Overall healing was 92.5 % in the open sphincterotomy group and 45 % in the toxin botulinum group ( P<.001 ) . There is a group of patients with clinical ( duration of disease > 12 months and presence of a sentinel pile before treatment ) and manometric factors ( persistently elevated mean resting pressure  , % of time presence of slow waves , and  number of patients or the time presence ultra slow waves after treatment ) associated with a higher recurrence of anal fissure . The final percentage of incontinence was 5 % in the open sphincterotomy group and 0 % in the botulinum toxin group ( P>.05 ) . CONCLUSION We recommend surgical sphincterotomy as the first therapeutic approach in patients with clinical and manometric factors of recurrence . We prefer the use of botulinum toxin in patients older than 50 years or with risk factors for incontinence , despite the higher rate of recurrence , since it avoids the greater risk of incontinence in the surgical group
Botox and CCBs were equivalent to GTN in efficacy with fewer adverse events .
No medical therapy came close to the efficacy of surgical sphincterotomy , though none in these RCTs was associated with the risk of incontinence .
Medical therapy for chronic anal fissure , acute fissure and fissure in children may be applied with a chance of cure that is marginally better than placebo , and , for chronic fissure in adults , far less effective than surgery
BACKGROUND Because of the disability associated with surgery for anal fissure and the risk of incontinence , medical alternatives for surgery have been sought .
Most recently , pharmacologic methods that relax the anal smooth muscle , to accomplish reversibly what occurs in surgery , have been used to obtain fissure healing .
OBJECTIVES To assess the efficacy and morbidity of various medical therapies for anal fissure .