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 .
Randomised trial of topical 0.2% glyceryl trinitrate and lateral internal sphincterotomy for the treatment of patients with chronic anal fissure: long-term follow-up.
OBJECTIVE To compare outcomes 24 months after treatment of chronic anal fissure with 0.2 % glyceryl trinitrate ointment ( GTN ) or lateral internal sphincterotomy .  DESIGN Prospect i ve , r and omised trial . SETTING One teaching , one private , and 3 district hospitals , U.K. SUBJECTS Seventy patients were r and omised into two groups of 35 each to use  0.2 % GTN ointment or have a lateral internal sphincterotomy .  MAIN OUTCOME MEASURES Resolution of symptoms and healing of fissures assessed after 24 months . RESULTS All those operated on were initially cured but one fissure recurred after 8 months . Nineteen of 35 fissures treated with GTN  healed . The remaining 16 patients r and omised to use GTN ointment whose fissures did not heal were then treated by sphincterotomy . Three patients whose fissures healed successfully with GTN developed recurrences within 6 months of completing treatment . The remaining 16 of 19 patients treated with GTN whose fissures healed were free of symptoms with no clinical evidence of recurrence after 24 months follow-up . CONCLUSIONS Many anal fissures heal with topical treatment with GTN . Lateral internal sphincterotomy remains effective but should be reserved for patients who fail to respond to initial chemical sphincterotomy
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 .