title: Fissure-in-ano, to divide or not to divide?
abstract: Anal fissure is one of the most common and painful proctological pathologies affecting mainly young individuals. The physiopathology in the development of a chronic anal fissure seems to be a combination of internal anal sphincter hypertonia and poor vascularization at the posterior midline. Treatment of acute fissures is conservative with supportive therapy, leading to healing in the majority of the patients. Open or closed lateral internal sphincterotomy is the treatment of choice for chronic anal fissures. In low pressure chronic fissures, sphincterotomy should be avoided and a V-Y island advancement flap may be an alternative procedure. Sphincterotomy can induce anal incontinence, a feared complication of this technique. Recent interest has developed in chemical sphincterotomy with local botulin toxin injections or glyceryl trinitrate application. Long-term follow-up is needed to evaluate these new therapeutic options.
authors.affiliation: Dept. of Surgery, University Hospital Sart-Tilman, Liège, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Brugman
authors.forename: L
authors.initials: L
authors.lastname: Bruyninx
authors.forename: N J
authors.initials: NJ
authors.lastname: Jacquet
mesh_terms: D000465:Algorithms; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000627:therapeutic use; D002908:Chronic Disease; D005401:Fissure in Ano / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D005996:Nitroglycerin / Q000627:therapeutic use; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D018726:Anti-Dyskinesia Agents; D014665:Vasodilator Agents; D001905:Botulinum Toxins; D005996:Nitroglycerin