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 .
Hydropneumatic anal dilation in conservative treatment of chronic anal
fissure: clinical outcomes and randomized comparison with topical
nitroglycerin
Abstract . Background The surgical approach in chronic anal fissures ( CAF ) may , occasionally result in anal incontinence . The aim of this investigation was to study feasibility , effectiveness , and safety of hydropneumatic anal dilation ( HAD ) in conservative treatment of CAF and to compare it with local nitroglycerin ( GTN ) treatment . Methods Efficacy of HAD was evaluated in 109 patients ( 65 male , 44 female ; mean age , 53.3 years ) , following anal dilation using Microvasive Rigiflex instrument ( Otw 40 mm ) . Thereafter , 36 patients were r and omly divided into two groups to undergo treatment with 0.25 % GTN or HAD . Results Recovery rate with HAD was 79.8 % after 10 days and 94.5 % after 30 days . An immediate ( within 24 hours ) drop was observed in the level of pain ; no significant complications or recurrence were reported within 2 years . Healing rate was 94.5 % following HAD vs. 38.9 % after GTN . Conclusion HAD should be considered a new safe option in CAF treatment
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 .