The surgical treatment of anal fissure

Anal fissure is one of the most common pathologies encountered in proctology. Operative techniques commonly used for anal fissure include: anal dilatation, sphincterotomy, fissurectomy and dermal flap coverage of the fissure. Surgical techniques have been used for over 100 years with success. Recently, less invasive methods of treatment have been explored aiming at reducing the spasm of the internal sphincter (“chemical sphincterotomy”). The choice of surgical vs. “chemical sphincterotomy” as the initial treatment for chronic anal fissure is at present controversial. The aim of this review was to analyze the results of the different surgical approaches in order to define their present role in the treatment of anal fissure. The evidence base strongly shows that surgery is still the most effective treatment for fissure at present.