Anal fissure treatment in 2022 - A global snapshot audit conducted by the International Society of University Colon and Rectal Surgeons (ISUCRS)

Abstract Background An anal fissure is a longitudinal tear in the mucosa of the anal canal, distal to the dentate line. It is usually situated in the posterior midline but can occur in any quadrant. This condition affects both genders and is associated with pain, bleeding, anal discomfort, amongst other symptoms. Aim The aim of this study is to evaluate the global treatment and follow-up of patients with anal fissures in different countries and continents. Method A prospective cohort audit database was created with the cooperation of fifty-six doctors from twenty-one different countries. The patients were evaluated according to the type of anal fissure they had, treatment they underwent and results of 8-week post-treatment. Results Overall, 302 patients were included, with 106 (35%) diagnosed with an acute anal fissure and 196 (65%) a chronic anal fissure. Leading symptoms were painful defecation (n = 280, 92.7%) followed by anal bleeding (n = 194, 64.2%) and painful bleeding during defecation (n = 182, 60.2%). A total of 111 (36.8%) underwent surgical treatment. Out of the 264 (87%) who underwent follow-up at 8-weeks, 116 patients (44%) were cured, 86 (32.6%) showed marked improvements, 46 patients (17.4%) showed some improvement, 16 (5.0%) reported no change and one patient (0.3%) had worsened symptoms. Complications arising after treatment was recorded in 18 (6%) patients, with 15 (83%) complaining of headaches, 2 (5%) indicated hypotension, perineal sepsis, anal bleeding and/or allergies to medications used during treatment. Comparing pre-treatment and post-treatment Wexner Incontinence Scores, no patients had worsening fecal incontinence, 95.7% showed stable scores, while 13 (4.3%) showed improved scores. Conclusion The majority of surgeons chose a non-surgical approach as a first line treatment for anal fissures whether acute or chronic. Overall, 94% of all patients had resolution or improved symptoms, with none of the surgically treated patients developing fecal incontinence afterwards.