Study on duration of symptoms of anal fissure and its impact on response to conservative treatment – A systemic review

Abstract

Conservative treatment is the main course of action for anal fissure. The goal of this review was to see how symptom duration affected the anal fissure's responsiveness to conservative treatment.In this systematic review, We evaluated the duration of symptoms related to anal fissure as well as their effect on the response to conservative treatment. The study was done by referring journals and articles from PUBMED, Scopus, web of science and Elsevier for a systemic review and references for additional studies. All the articles and literature other than in English language are excluded. Atypical fissures which occur due to conditions like cancer, anal infection and inflammatory bowel disease are excluded. The key search words used are Anal fissure , Fissure in anal and conservative treatment, symptoms of anal fissure , Anal fissure and Glycery l Tri Nitrate (GTN), Anal fissure and Botox, Anal fissure and pathophysiology, Anal fissure and calcium channel Blockers, classification of anal fissure. A total yielded 1048 articles on initial search; first 614 duplicate publications were removed. After screening additional 467 articles were excluded and 147 full articles were assessed for the study. After performing complete screening data analysis of total 14 literature were involved in this present systematic review.This Systemic review can be concluded by the above mentioned finding that if symptom duration is less or in other words in acute anal fissures conservative treatment methods can work very effectively especially with GTN. However, as the duration of symptoms exceed the healing rate decreases attributing to the chronicity of the anal fissures. This renders the conservative treatment modalities less effective and making surgical treatment alternatives like Lateral internal sphincterotomy (LIS) the mainstay for chronic anal fissure.