SynthesisInternational journal of colorectal disease2020
Management options for chronic anal fissure: a systematic review of randomised controlled trials.
Synthesis in International journal of colorectal disease, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled 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.
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.
Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 74 citations in OpenAlex.
- Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials.Langenbeck's archives of surgery · 2024Pooled it
- The role of percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic anal fissure: a systematic review.International journal of colorectal disease · 2021Pooled it
- Pelvic floor physical therapy in patients with chronic anal fissure: long-term follow-up of a randomized controlled trial.International journal of colorectal disease · 2023Trial
- Pelvic floor physical therapy in patients with chronic anal fissure: a randomized controlled trial.Techniques in coloproctology · 2022Trial
- The Effect of Ostrich Oil on Pain, Healing, and Recurrence of Chronic Anal Fissure: A Randomized Controlled Double-Blind Clinical Trial.Health science reports · 2026Article
- Article
- The Effect of Sphincter Pressure and Anal Length on Surgical Decision in Chronic Anal Fissure.Journal of clinical medicine · 2025Article
- Management of chronic anal fissures: should fissurectomy be performed with botulinum toxin injection?Techniques in coloproctology · 2025Article
- Management of gastrointestinal bleed in the intensive care setting, an updated literature review.World journal of critical care medicine · 2025Review
- Retrospective analysis on the efficacy of botulinum toxin alone versus combined botulinum toxin and topical diltiazem.International journal of colorectal disease · 2025Article
- Anal fissures in COVID-19 survivors: Incidence, risk factors, and outcomes.Turkish journal of surgery · 2024Article
- Tailored lateral internal sphincterotomy (T-LIS) for chronic anal fissure by LigaSure Small Jaws©: a comparison with other non-conservative treatments for anal fissures.Updates in surgery · 2024Article
- Is chemodenervation with incobotulinumtoxinA an alternative to invasive chronic anal fissure treatments?BMC gastroenterology · 2024Article
- Anal Fissure and Its Treatments: A Historical Review.Journal of clinical medicine · 2024Review
- The Assessment of Marcaine Versus Meperidine for Spinal Anesthesia in Anorectal Surgery: A Randomized Clinical Trial.Anesthesiology and pain medicine · 2023Article
- Safety and efficacy of Levorag emulgel in the treatment of anal fissures using a validated scoring system.Frontiers in surgery · 2023Article
- Article
- Off-Label Use of Botulinum Toxin in Dermatology-Current State of the Art.Molecules (Basel, Switzerland) · 2022Review
- Botulinum toxin injection for the treatment of chronic anal fissure: uni- and multivariate analysis of the factors that promote healing.International journal of colorectal disease · 2022Article
- Pelvic floor physical therapy in the treatment of chronic anal fissure (PAF-study): Study protocol for a randomized controlled trial.Contemporary clinical trials communications · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionAnal fissure is the most common cause of severe anorectal pain in adults, contributing significantly to coloproctology workloads. There are a wide variety of management options available, including topical nitrites, calcium channel blockers, botulinum toxin injection and sphincterotomy. The aim of this study was to review current options for the treatment of chronic anal fissure.
methodsA comprehensive search identifying randomized controlled trials comparing treatment options for anal fissure published between January 2000 and February 2020 was performed. The primary outcome assessed was healing at 8 weeks post commencing treatment. Secondary outcomes included recurrence, intolerance of treatment and complications.
resultsA total of 2822 studies were identified. After removal of duplicates and non-relevant studies, we identified nine randomized controlled trials which met pre-defined criteria. There was a total of 775 patients. At 8 weeks, healing rates were 95.13% in those treated with sphincterotomy, 66.7% in the botulinum toxin group, 63.8% in the nitrate group, 52.3% for topical diltiazem and 50% for topical minoxidil. Recurrence was highest amongst those treated with botulinum toxin injection (41.7%) and lowest for sphincterotomy (6.9%). Although the absolute number is low, there was a risk of permanent incontinence with sphincterotomy.
conclusionThis review of the randomized control data demonstrates that healing was significantly higher amongst those treated with sphincterotomy versus more conservative modalities. Topical nitrites had similar outcomes to botulinum toxin injection but were poorly tolerated in comparison to other treatments. The benefit of sphincterotomy was at a cost of increased complications, notably permanent incontinence.
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What OpenQuestion holds
Registered trials
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.