title: Cost considerations in the treatment of anal fissures.
abstract: Anal fissure is a split in the lining of the distal anal canal. Lateral internal sphincterotomy remains the gold standard for treatment of anal fissure. Although technique is simple and effective, a drawback of this surgical procedure is its potential to cause minor but some times permanent alteration in rectal continence. Conservative approaches (such as topical application of ointment or botulinum toxin injections) have been proposed in order to treat this condition without any risk of permanent injury of the internal anal sphincter. These treatments are effective in a large number of patients. Furthermore, with the ready availability of medical therapies to induce healing of anal fissure, the risk of a first-line surgical approach is difficult to justify. The conservative treatments have a lower cost than surgery. Moreover, evaluation of the actual costs of each therapeutic option is important especially in times of economic crisis and downsizing of health spending.
authors.affiliation: Department of Surgery, Catholic School of Medicine, University Hospital "Agostino Gemelli", Largo Agostino Gemelli 8, 00168, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Brisinda
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bianco
authors.forename: Nicola
authors.initials: N
authors.lastname: Silvestrini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Maria
mesh_terms: D001003:Anal Canal / Q000503:physiopathology* / Q000601:surgery; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000191:economics; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology*; D005401:Fissure in Ano / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D001905:Botulinum Toxins
keywords: anus; autonomic nervous system disease; botulinum toxin; calcium channel blockers; cost analysis; evidence-based medicine; fissure-in-ano; lateral internal sphincterotomy; surgery