Anal fissure in XXXX : a plea for aggressive management.

@entity1 @entity292 @entity733 @entity30
PURPOSE: This study was undertaken to identify clinical characteristics, natural history, and results of medical and surgical treatment of anal fissures in @entity30 . METHODS: This is a retrospective review of @entity1 with @entity30 and anal fissure. RESULTS: Of the 56 study @entity1 , 49 (84 percent) had symptomatic fissures. Fissures were most commonly (66 percent) located in the posterior midline, and 18 @entity1 (32 percent) had multiple fissures. Fissures healed in one-half of @entity1 treated medically. Factors predictive of successful medical treatment included male gender, painless fissure, and acute fissure. Of 15 @entity1 , 10 (67 percent) treated surgically healed. Fissures in seven of eight @entity1 (88 percent) who underwent anorectal procedures healed compared with fissures in only three of seven @entity1 (43 percent) who underwent proximal intestinal resection. In the group of 50 @entity1 with complete follow-up studies, an @entity733 or @entity292 from the base of an unhealed fissure developed in 13 @entity1 (26 percent). More fissures healed after anorectal surgery (88 percent) than after medical treatment alone (49 percent; P = 0.05) or after abnormal surgery (29 percent; P = 0.03). CONCLUSION: This series documents that unhealed fissures frequently progress to more ominous anal pathologic disease. Judicious use of internal sphincterotomy appears to be safe for fissures unresponsive to medical treatment.
