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 or biologic sphincterotomy in the treatment of chronic anal fissure].
BACKGROUND Chronic anal fissure is a lineal ulcer of the lower part of the anal canal . It is a painful condition characterized by postdefecational pain and bleeding . It is associated with internal anal sphincter spasm . The relief of internal anal sphincter spasm is the key for providing fissure healing . Gold st and ard in the treatment of chronic anal fissure is partial lateral internal anal sphincterotomy . METHODS Sixty patients with chronic anal fissure were r and omly assigned into two groups treated either by surgical sphincterotomy or injections of botulinum toxin into internal anal sphincter .  Manometric measurements were performed before and three months after treatment . Follow up period was six months . The aim of the study was to compare results between these two groups . RESULTS Both methods efficiently reduced resting anal pressure and successfully healed chronic anal fissure . CONCLUSION Surgical and biologic sphincterotomy are almost equally effective in the treatment of chronic anal fissure . Injecting botulinum toxin into internal anal sphincter is a safe , easy to apply and effective method in the management of anal fissure
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 .