title: [Treatment of chronic anal fissure].
abstract: Chronic anal fissure is a common benign anorectal problem in Western countries that substantially impairs the patient's life. Consequently, a rapid and effective solution is required. We reviewed the various treatments for chronic anal fissure described in the literature, with the aim of establishing a therapeutic protocol. We recommend surgical sphincterotomy (preferably open or closed lateral sphincterotomy) as the first therapeutic approach in patients with chronic anal fissure. However, we prefer the use of chemical sphincterotomy (preferably botulinum toxin) in patients aged more than 50 years old and in those with previous incontinence, risk factors for incontinence (previous anal surgery, multiple vaginal births, diabetes, inflammatory bowel disease, etc.), or without anal hypertonia, despite the higher recurrence rate with medical treatments, since this procedure avoids the greater risk of residual incontinence described in the literature with surgical sphincterotomy in this group of patients.
authors.affiliation: Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario de Elche, Elche, Alicante, Spain. arroyocir@hotmail.com
authors.forename: Antonio
authors.initials: A
authors.lastname: Arroyo
authors.forename: Francisco
authors.initials: F
authors.lastname: Pérez-Vicente
authors.forename: Pilar
authors.initials: P
authors.lastname: Serrano
authors.forename: Fernando
authors.initials: F
authors.lastname: Candela
authors.forename: Ana
authors.initials: A
authors.lastname: Sánchez
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Pérez-Vázquez
authors.forename: Rafael
authors.initials: R
authors.lastname: Calpena
mesh_terms: D001905:Botulinum Toxins / Q000627:therapeutic use; D002908:Chronic Disease; D005401:Fissure in Ano / Q000601:surgery / Q000628:therapy*; D006801:Humans
chemical_list: D001905:Botulinum Toxins