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 .
Randomized, placebo-controlled treatment of anal fissure by lidocaine, EMLA, and GTN in children.
BACKGROUND / PURPOSE Anal fissures would result in constipation in children , worsening the clinical picture , thus , justifying a fast response therapy . In this r and omized , prospect i ve , placebo-controlled study , it was aim ed to determine the response rates to fissure treatment by lidocaine , EMLA and GTN on the 10th day and after 8 weeks of therapy . Related childhood literature is scarce , and EMLA is tried for the first time in fissure treatment . METHODS One hundred two children with anal fissures were allocated r and omly into 4 groups . Placebo group ( P ; n = 20 ) received vaseline ; group L ( n = 24 ) , 10 % lidocaine ; group EMLA ( n = 25 ) , eutectic mixture of 5 % prilocaine-5 % lidocaine ; and group GTN ( n = 22 ) , 0.2 % glyceryl trinitrate ointment twice daily to the distal anal canal . Symptoms and physical findings were separately scored as 0 , 1 , and 2 . On the 10th day , the number of patients with scores of 0 ( unresponsive ) and in the 8th week with scores of 2 ( healed and symptom free ) were analyzed statistically . RESULTS Ninety-one patients completed the study . On the 10th day children with 0 symptomatic and fissure healing scores were , respectively , 90 % to 95 % in group P , 75 % to 80 % in group L , 20 % to 40 % in group EMLA , and 5 % to 10 % in group GTN . These results were statistically significant . In the eighth week , children with symptomatic and healing scores of 2 were , respectively , 10 % to 5 % in group P , 42 % to 29 % in group L , 76 % to 64 % in group EMLA , and 91 % to 82 % in group GTN . Results in groups GTN and EMLA were statistically similar ( P > .05 ) and better than the other 2 groups ( P < .05 ) . CONCLUSION Faster response rates could be achieved by GTN application , and similar and high success rates could be gained by GTN or EMLA by 8 weeks of 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 .