Evidence map›Paper›PMID 28396998›Full record

ReviewJournal of gastroenterology2017

Operative and medical treatment of chronic anal fissures-a review and network meta-analysis of randomized controlled trials.

Sabrina Maria Ebinger, Julia Hardt, René Warschkow, Bruno Martin Schmied, Alexander Herold, Stefan Post, Lukas Marti

Abstract readComparative StudyReviewNetwork Meta-Analysis
PubMed Publisher
In one paragraph

Review in Journal of gastroenterology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 5 pooled it
6.7field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 5 syntheses or guidelines pooled it, 94 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
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  4. Pooled it
  5. Anorectal emergencies: WSES-AAST guidelines.World journal of emergency surgery : WJES · 2021
    Pooled it
  6. Trial
  7. Article
  8. Article
  9. [Chronic anal fissure-Cremes or surgery?]Chirurgie (Heidelberg, Germany) · 2025
    Review
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Observational
  17. Article
  18. Article
  19. Article
  20. [Rectal bleeding: easy to overcome or still a challenge in proctology?]Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2019
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 5 institutions in 2 countries.

Sabrina Maria EbingerDepartment of Surgery, Cantonal Hospital of St. Gallen, 9007, St. Gallen, Switzerland.
Julia HardtDepartment of Surgery, Medical Faculty Mannheim, University of Heidelberg, 68167, Mannheim, Germany.
René WarschkowDepartment of Surgery, Cantonal Hospital of St. Gallen, 9007, St. Gallen, Switzerland.
Bruno Martin SchmiedDepartment of Surgery, Cantonal Hospital of St. Gallen, 9007, St. Gallen, Switzerland.
Alexander HeroldDepartment of Surgery, Medical Faculty Mannheim, University of Heidelberg, 68167, Mannheim, Germany.
Stefan PostDepartment of Surgery, Medical Faculty Mannheim, University of Heidelberg, 68167, Mannheim, Germany.
Lukas MartiDepartment of Surgery, Cantonal Hospital of St. Gallen, 9007, St. Gallen, Switzerland. lukas.marti@kssg.ch.
University Hospital Heidelberg · DESpital STS · CHUniversity Medical Centre Mannheim · DEUniversity of St. Gallen · CHZimmer Biomet (Germany) · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Anal fissures are a common problem and have a cumulative lifetime incidence of 11%. Previous reviews on anal fissures show inconsistent results regarding post-interventional healing and incontinence rates. In this review our aim was to compare the treatments for chronic anal fissures by incorporating indirect comparisons using network meta-analysis. The PubMed database was searched for randomized controlled trials (RCTs) published between 1975 and 2015. The primary outcome measures were healing and incontinence rates after lateral internal sphincterotomy (LIS), anal dilatation (DILA), anoplasty and/or fissurectomy (FIAP), botulinum toxin (BT) and noninvasive treatment (NIT). Random effects network meta-analyses were complemented by fixed effects and Bayesian models. The present analysis included 44 RCTs and 3268 patients. After a median follow-up of 2 months, the healing rates for LIS, DILA, FIAP, BT and NIT were 93.1, 84.4, 79.8, 62.6, and 58.6% and the incontinence rates were 9.4, 18.2, 4.9, 4.1, and 3.0%, respectively. Compared with NIT, the odds ratio (OR) [95% confidence interval (CI)] for healing after LIS, DILA, FIAP and BT was 9.9 (5.4-18.1), 8.6 (3.1-24.0), 3.5 (1.0-12.7) and 1.9 (1.1-3.5), respectively, on network meta-analysis. The OR (95% CI) for incontinence after LIS, DILA, FIAP and BT was 6.8 (3.1-15.1), 16.9 (6.0-47.8), 3.9 (1.0-15.1) and 1.6 (0.7-3.7), respectively. Ranking of treatments, fixed effects and Bayesian models confirmed these findings. In conclusion, based on our meta-analysis LIS is the most efficacious treatment but is compromised by a high rate of postoperative incontinence. Given the trade-offs between the risks and benefits, FIAP and BT might be good alternatives for the treatment of chronic anal fissures.

Indexed as

Bayes TheoremBotulinum ToxinsChronic DiseaseFecal IncontinenceFissure in AnoHumansLateral Internal SphincterotomyPostoperative ComplicationsRandomized Controlled Trials as TopicTreatment OutcomeBotulinum ToxinsBotulinum toxinChronic anal fissuresLateral internal sphincterotomyNetwork meta-analysisNoninvasive treatment

Identifiers

PMID28396998
OpenAlexW2605902280

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.