Temporal trends and treatment patterns in anal fissure management: insights from a multicenter study in Italy
Authors: Picciariello A. , Tutino R. , Gallo G. , Altomare D. F. , Pietroletti R. , Dezi A. , Graziano G. ,   SICCR Anal Fissure Group, Fabio Ambrosini , Alfredo Annicchiarico , Nicola Antonacci , Francesca Ascari , Pasquale Ascenzi , Andrea Balla , Giuliano Barugola , Luigi Basso , Claudio Beati , Vittoria Bellato , Emanuela Benatti , Paolo Bertoli , Corrado Bottini , Salvatore Bracchitta , Danilo Cafaro , Marco Calussi , Filippo Caminati , Giuseppe Candilio , Salvatore Cantarella , Fabio Carbone , Stefano Carini , Francesco Carrino , Giovanni Cestaro , Antonella Chessa , Enrico Ciferri , Marco Clementi , Claudio Coco , Gianfranco Cocorullo , Francesco Colombo , Andrea Comba , Luigi Conti , Nicola Cracco , Francesca Cravero , Nicola Crea , Fabio Crescenti , Salvatore Cuccomarino , Fabrizio D’Acapito , Giuliano D’Onghia , Michele De Rosa , Daniela Di Pietrantonio , Giuseppe Dodi , Luca Ferrario , Tommaso Fontana , Nicola Foti , Carmelo Geremia , Ivana Giannini , Pasquale Giordano , Antonio Giuliani , Eleonora Guaitoli , Rita Laforgia , Giuliano Lantone , Maria Lemma , Giorgio Lisi , Pierluigi Lobascio , Federico Lovisetto , Enrico Lucci , Francesco Madeddu , Costantino Magnani , Davide Mascali , David Merlini , Giovanni Milito , Antonio Miro , Elisabetta Moggia , Iacopo Monaci , Marta Mozzon , Luca Navarra , Angelo Oggianu , Simone Orlandi , Alessio Palumbo , Umberto Passaro , Francesco Pata , Giuseppe Pecorella , Corrado Pedrazzani , Davide Piccolo , Giulia Poli , Marcella Rinaldi , Valter Ripetti , Salvatore Rizzo , Giuseppe Rocco , Michele Sacco , Giuliano Saroglia , Bruno Scotto , Lucio Selvaggi , Vania Silvestri , Gabriele Soldini , Nicolò Tamini , Cinzia Tanda , Giovanni Terrosu , Alessandro Testa , Giovanni Tomasicchio , Luca Turati , Natale Ursino , Alberto Vannelli , Gabriele Viola , Tommaso Violante , Daniele Zigiotto , Grossi U. 
Published: October 2024

Abstract
Introduction
Anal fissure (AF) poses a common challenge in clinical practice, prompting various treatment approaches. This multicenter study, conducted by the Italian Society of Colorectal Surgery, aimed to assess treatment trends in AF over a 10 year period.

Methods
A survey of proctologists and retrospective analysis of patient records were conducted to evaluate treatment modalities and outcomes across six different clinical scenarios based on AF presentation (acute/chronic) stratified by sphincter function (normal/hypertonic/hypotonic).

Results
Analysis of data from 17 principal investigators and 22,016 patients revealed significant variability in treatment approaches, influenced by factors such as symptom duration, anal tone, and surgeon preference. Conservative treatments were commonly utilized, while surgical interventions were reserved for refractory cases. Specifically, pharmaceutical treatment was administered to 66–75% of patients in cases of acute AF and 63–67% for chronic AF, while 10–15% underwent anal dilation, and < 2% received botulinum toxin injection. Among medical treatments, nifedipine with lidocaine and glycerin film-forming ointments were the most utilized. The most performed surgical techniques were fissurectomy and anoplasty, except for patients with chronic AF and hypertonic sphincter where sphincterotomy prevailed. Trends in treatment utilization varied depending on the clinical scenario, with notable shifts observed over time.

Conclusions
This study provides insights into the evolving landscape of AF management, highlighting the need for further research to elucidate optimal treatment strategies and improve patient outcomes.