TREATMENT OF ACUTE AND CHRONIC ANAL FISSURES: A
COMPARATIVE ANALYSIS OF CONSENSUS AND DIFFERENCES IN INTERNATIONAL GUIDELINES
Mehmet Eren Yuksel
Etlik City Hospital, Surgical Critical Care Unit,
Ankara, Turkiye
e-mail: doctormehmeteren@yahoo.com
Orcid ID: https://orcid.org/0000-0002-7110-0717
ABSTRACT
Introduction: Anal
fissures are a frequent cause of anorectal pain and bleeding, typically
presenting as linear tears in the anoderm. Four major societies, World Society
of Emergency Surgery and American Association for the Surgery of Trauma
(WSES/AAST), American College of Gastroenterology (ACG), Association of
Coloproctology of Great Britain and Ireland (ACPGBI) and American Society of
Colon and Rectal Surgeons (ASCRS) have published guidelines for their
management.
Method: This study
compared the latest guidelines from the WSES/AAST (2021), ACG (2021), ACPGBI
(2023), and ASCRS (2023).
Results and Discussion: All
four guidelines recommend dietary fiber, stool softeners, hydration, and sitz
baths for acute fissures. For chronic cases, ACPGBI and ASCRS prefer topical
diltiazem or glyceryl trinitrate, whereas ACG and WSES/AAST offer either option
without preference. Botulinum toxin is generally a second-line option, although
WSES/AAST allows for earlier use in high-risk patients. Lateral internal
sphincterotomy is universally accepted as the definitive treatment for
refractory cases, with ACPGBI and ASCRS emphasizing tailored approaches to
minimize incontinence.
Conclusion: A
unified evidence-based guideline incorporating diverse clinical scenarios would
support more consistent and patient-centered care.
Keywords: Anal fissure,
Botulinum toxin, Guideline, Lateral internal sphincterotomy
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