What are alternative techniques for surgical treatment of chronic anal fissures?

Updated: Nov 09, 2018
  • Author: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Other surgical techniques have been described, including a more tailored approach, which showed lower rates of complications but higher rates of treatment failure. [42, 43, 44] LIS has been shown to have a higher rate of cure than anal dilation. Data for subcutaneous fissurectomy with anal advancement flap are limited, but promising. [17, 45]

Success has been reported for chronic anal fissure with associated anal fistula using a combined approach of  fistulotomy and injection of botulinum A toxin. [46] A retrospective, observational study (2013-2016) of 20 patients with fissure-fistula treated with fistulotomy and botulinum toxin A found resolution of symptoms in all patients who attended follow-up appointments (mean, 10.5 weeks), with no reports of incontinence and no further operation required. [46]

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