Temporal trends and treatment patterns in anal fissure management: insights from a multicenter study in Italy

• Published in: Techniques in coloproctology Vol. 28; no. 1; p. 139
• Main Authors: Picciariello, A., Tutino, R., Gallo, G., Altomare, D. F., Pietroletti, R., Dezi, A., Graziano, G., Grossi, U.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 2024; Springer Nature B.V
• Subjects: Abdominal Surgery; Acute Disease; Adult; Anal Canal - surgery; Chronic Disease; Colorectal Surgery; Conservative Treatment - methods; Conservative Treatment - statistics & numerical data; Dilatation - methods; Dilatation - statistics & numerical data; Female; Fissure in Ano - therapy; Gastroenterology; Humans; Italy; Lidocaine - administration & dosage; Lidocaine - therapeutic use; Male; Medical treatment; Medicine; Medicine & Public Health; Middle Aged; Nifedipine - therapeutic use; Nitroglycerin - administration & dosage; Nitroglycerin - therapeutic use; Observational studies; Original; Original Article; Patients; Practice Patterns, Physicians' - statistics & numerical data; Practice Patterns, Physicians' - trends; Proctology; Retrospective Studies; Sphincterotomy - methods; Sphincterotomy - statistics & numerical data; Surgery; Treatment Outcome; Trends; Italy; Anal fissure; Surgery; Botulinum toxin injection; Sphincterotomy; Fissurectomy; Trends; Conservative treatment
• ISSN: 1123-6337; 1128-045X; 1128-045X
• DOI: 10.1007/s10151-024-03011-4

Introduction
Anal fissure (AF) poses a common challenge in clinical practice, prompting various treatment approaches. This multicenter study, conducted by the Italian Society of Colorectal Surgery, aimed to assess treatment trends in AF over a 10 year period.
Methods
A survey of proctologists and retrospective analysis of patient records were conducted to evaluate treatment modalities and outcomes across six different clinical scenarios based on AF presentation (acute/chronic) stratified by sphincter function (normal/hypertonic/hypotonic).
Results
Analysis of data from 17 principal investigators and 22,016 patients revealed significant variability in treatment approaches, influenced by factors such as symptom duration, anal tone, and surgeon preference. Conservative treatments were commonly utilized, while surgical interventions were reserved for refractory cases. Specifically, pharmaceutical treatment was administered to 66–75% of patients in cases of acute AF and 63–67% for chronic AF, while 10–15% underwent anal dilation, and < 2% received botulinum toxin injection. Among medical treatments, nifedipine with lidocaine and glycerin film-forming ointments were the most utilized. The most performed surgical techniques were fissurectomy and anoplasty, except for patients with chronic AF and hypertonic sphincter where sphincterotomy prevailed. Trends in treatment utilization varied depending on the clinical scenario, with notable shifts observed over time.
Conclusions
This study provides insights into the evolving landscape of AF management, highlighting the need for further research to elucidate optimal treatment strategies and improve patient outcomes.