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 .
Topical 0.5% nifedipine vs. lateral internal sphincterotomy for the treatment of chronic anal fissure: long-term follow-up
Background The aim of this study was to compare the efficacy of the local application of 0.5 % nifedipine ointment vs. lateral internal sphincterotomy in the healing of chronic anal fissure .  Patients and methods Sixty-four patients with symptomatic chronic anal fissures were r and omly assigned to 0.5 % nifedipine ointment ( n=32 ) every 8 h for 8 weeks or lateral internal sphincterotomy ( n=32 ) . Both groups received stool softeners and fiber supplements and were assessed at 2 , 4 , 6 , and 8 weeks . Long-term outcomes were determined after a median follow-up of 19 months ( nifedipine group ) and 20.5 months ( lateral internal sphincterotomy group ) . Results Complete healing at 8 weeks was achieved in 30 out of 31 patients ( 96.7 % ) in the nifedipine group and 32 out of 32 patients ( 100 % ) in the lateral internal sphincterotomy group ( p=0.49 ) . The overall healing rates at the end of follow-up were 28 out of 30 ( 93 % ) vs. 32 out of 32 ( 100 % ) in the nifedipine and sphincterotomy groups respectively ( p=0.48 ) . Two of the 30 patients in the nifedipine group relapsed whereas none in the sphincterotomy group did . Sixteen patients ( 50 % ) developed side effects in the nifedipine group , compared with six patients ( 18.7 % ) in the sphincterotomy group . Conclusions Topical application of 0.5 % nifedipine ointment represents a new , promising , easily h and led , effective alternative to lateral internal 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 .