title: Effect of chronic anal fissure components on isosorbide dinitrate treatment.
abstract: BACKGROUND
  Chronic anal fissure is diagnosed in the presence of persistent symptoms: The classic triad includes a linear mucosal tear exposing the internal sphincter fibers, hypertrophied anal papilla, and a sentinel skin tag. Thus, chronic anal fissure can be divided into three components: the fissure itself; hypertrophied anal papilla; the sentinel skin tag. Not every chronic anal fissure has all three components; some have two components, and others present with only a persistent fissure. The success rate of medical treatment for chronic anal fissure is reported as 42-86 %. In this study, we intended to observe the effect of said components on healing with isosorbide dinitrate treatment.
  
  
  METHODS
  A total of 105 patients with chronic anal fissures were admitted and were divided into three groups. Patients in group I had a single component (only the fissure with a linear mucosal tear exposing the internal sphincter fibers); group II had two components (skin tag or hypertrophied papilla in addition to the fissure); group III had all three components (fissure, skin tag, hypertrophied papilla). Isosorbide dinitrate 0.25 % was applied three times a day.
  
  
  RESULTS
  The success rates in the study groups were 93, 74, and 64 %, respectively. The success rate was significantly higher for group I than for groups II and III.
  
  
  CONCLUSIONS
  Chronic anal fissure components should be considered when evaluating the success rates of studies reporting the results of various medical treatments. The number of components seems to be an important factor that affects the results of isosorbide dinitrate treatment.
authors.affiliation: Department of General Surgery, Konya Training and Research Hospital, Konya 42100, Turkey. arslanka74@hotmail.com
authors.forename: K
authors.initials: K
authors.lastname: Arslan
authors.forename: B
authors.initials: B
authors.lastname: Erenoğlu
authors.forename: O
authors.initials: O
authors.lastname: Doğru
authors.forename: S
authors.initials: S
authors.lastname: Kökçam
authors.forename: E
authors.initials: E
authors.lastname: Turan
authors.forename: A
authors.initials: A
authors.lastname: Atay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D005401:Fissure in Ano / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007548:Isosorbide Dinitrate / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use*; D014945:Wound Healing / Q000187:drug effects; D055815:Young Adult
chemical_list: D014665:Vasodilator Agents; D007548:Isosorbide Dinitrate