A review of chronic anal fissure management

Emma Collins1, Jonathan N. Lund1
1Department of Surgery, University of Nottingham Medical School at Derby Derby City General Hospital, Derby, UK

Tóm tắt

Từ khóa


Tài liệu tham khảo

Sailer M, Bussen D, Debus ES, Fuchs KH, Thiede A (1998) Quality of life in patients with benign anorectal disorders. Br J Surg 85:1716–1719

Griffin N, Acheson AG, Tung P, Sheard C, Glazebrook C, Scholefield JH (2004) Quality of life in patients with chronic anal fissure. Colorectal Dis 6:39–44

— (2003) American Gastroenterological Association medical position statement: diagnosis and care of patients with anal fissure. Gastroenterology 124:233–234

Lindsey I, Jones OM, Cunningham C, Mortensen NJ (2004) Chronic anal fissure. Br J Surg 91:270–279

Goligher JC (1984) Surgery of the anus, rectum and colon. Bailliere Tindall, London

Lund JN, Scholefield JH (1996) Aetiology and treatment of anal fissure. Br J Surg 83:1335–1344

Hananel N, Gordon PH (1997) Re-examination of clinical manifestations and response to therapy of fissure-in-ano. Dis Colon Rectum 40:229–233

Brodie BC (1835) Lectures on diseases of the rectum; III; Preturnatural contraction of the sphincter ani. London Medical Gazette 16:26–31

Rattan S (2005) The internal and sphincter: regulation of smooth muscle tone and relaxation. Neurogastroenterol Motil 17[Suppl 1]:50–59

Rattan S, Regan RF, Patel CA, De Godoy MA (2005) Nitric oxide not carbon monoxide mediates nonadrenergic non-cholinergic relaxation in the murine internal anal sphincter. Gastroenterology 129:1954–1966

Rattan S, Chakder S (1992) Role of nitric oxide as a mediator of internal anal sphincter relaxation. Am J Physiol 262:G107–G112

Rattan S, Sarkar A, Chakder S (1992) Nitric oxide pathway in rectoanal inhibitory reflex of opossum internal anal sphincter. Gastroenterology 103:43–50

Chakder S, Rattan S (1993) Release of nitric oxide by activation of nonadrenergic noncholinergic neurons of internal anal sphincter. Am J Physiol 264:G7–G12

O’Kelly TJ (1996) Nerves that say NO: a new perspective on the human rectoanal inhibitory reflex. Ann R Coll Surg Engl 78:31–38

Griffin N, Zimmerman DD, Briel JW et al (2002) Topical L-arginine gel lowers resting anal pressure: possible treatment for anal fissure. Dis Colon Rectum 45:1332–1336

Acheson AG, Griffin N, Scholefield JH, Wilson VG (2003) L-Arginine-induced relaxation of the internal anal sphincter is not mediated by nitric oxide. Br J Surg 90:1155–1162

Biancani P, Walsh J, Behar J (1985) Vasoactive intestinal peptide: a neurotransmitter for relaxation of the rabbit internal anal sphincter. Gastroenterology 89:867–874

Nurko S, Rattan S (1988) Role of vasoactive intestinal polypeptide in the internal anal sphincter relaxation of the opossum. J Clin Invest 81:1146–1153

Rattan S, Chakder S (1997) Excitatory and inhibitory actions of pituitary adenylate cyclase-activating peptide (PACAP) in the internal anal sphincter smooth muscle: sites of actions. J Pharmacol Exp Ther 283:722–728

Lock MR, Thomson JP (1977) Fissure-in-ano: the initial management and prognosis. Br J Surg 64:355–358

McDonald P, Driscoll AM, Nicholls RJ (1983) The anal dilator in the conservative management of acute anal fissures. Br J Surg 70:25–26

Lund JN (2006) Nitric oxide deficiency in the internal anal sphincter of patients with chronic anal fissure. Int J Colorectal Dis 21:673–675

Lund JN, Scholefield JH (1997) Internal sphincter spasm in anal fissure. Br J Surg 84:1723–1724

Mearin F, Mourelle M, Guarner F et al (1993) Patients with achalasia lack nitric oxide synthase in the gastro-oesophageal junction. Eur J Clin Invest 23:724–728

Schouten WR, Briel JW, Auwerda JJ, De Graaf EJ (1996) Ischaemic nature of anal fissure. Br J Surg 83:63–65

Lund JN, Binch C, McGrath J, Sparrow RA, Scholefield JH (1999) Topographical distribution of blood supply to the anal canal. Br J Surg 86:496–498

Klosterhalfen B, Vogel P, Rixen H, Mittermayer C (1989) Topography of the inferior rectal artery: a possible cause of chronic, primary anal fissure. Dis Colon Rectum 32:43–52

Corby H, Donnelly VS, O’Herlihy C, O’Connell PR (1997) Anal canal pressures are low in women with postpartum anal fissure. Br J Surg 84:86–88

Favetta U, Amato A, Interisano A, Pescatori M (1996) Clinical, manometric and sonographic assessment of the anal sphincters. A comparative prospective study. Int J Colorectal Dis 11:163–166

Bove A, Balzano A, Perrotti P, Antropoli C, Lombardi G, Pucciani F (2004) Different anal pressure profiles in patients with anal fissure. Tech Coloproctol 8:151–156

Rosen L, Abel ME, Gordon PH et al (1992) Practice parameters for the management of anal fissure. The Standards Task Force American Society of Colon and Rectal Surgeons. Dis Colon Rectum 35:206–208

Recamier JC (1838) Extension, massage et percussion cadancee dans le traitment des contractures musculaires. Rev Med Fr Estrang 1:74

Marby M, Alexander-Williams J, Buchmann P et al (1979) A randomized controlled trial to compare anal dilatation with lateral subcutaneous sphincterotomy for anal fissure. Dis Colon Rectum 22:308–311

Graham-Stewart CW, Greenwood RK, Lloyd-Davies RW (1961) A review of 50 patients with fissure in ano. Surg Gynecol Obstet 113:445–448

Fries B, Rietz KA (1964) Treatment of fissure in ano. Acta Chir Scand 128:312–315

Watts JM, Bennett RC, Goligher JC (1964) Stretching of anal sphincters in treatment of fissure-in-ano. Br Med J 2:342–343

Sohn N, Eisenberg MM, Weinstein MA, Lugo RN, Ader J (1992) Precise anorectal sphincter dilatation—its role in the therapy of anal fissures. Dis Colon Rectum 35:322–327

MacDonald A, Smith A, McNeill AD, Finlay IG (1992) Manual dilatation of the anus. Br J Surg 79:1381–1382

Isbister WH, Prasad J (1995) Fissure in ano. Aust N Z J Surg 65:107–108

Moore KT (1975) The outpatient treatment of fissure-in-ano. Br J Clin Pract 29:181–182

Hawley PR (1969) The treatment of chronic fissure-in-ano. A trial of methods. Br J Surg 56:915–918

Saad AM, Omer A (1992) Surgical treatment of chronic fissure-in-ano: a prospective randomised study. East Afr Med J 69:613–615

Weaver RM, Ambrose NS, Alexander-Williams J, Keighley MR (1987) Manual dilatation of the anus vs. lateral subcutaneous sphincterotomy in the treatment of chronic fissure-in-ano. Results of a prospective, randomized, clinical trial. Dis Colon Rectum 30:420–423

Olsen J, Mortensen PE, Krogh Petersen I, Christiansen J (1987) Anal sphincter function after treatment of fissure-in-ano by lateral subcutaneous sphincterotomy versus anal dilatation. A randomized study. Int J Colorectal Dis 2:155–157

Collopy B, Ryan P (1979) Comparison of lateral subcutaneous sphincterotomy with anal dilatation in the treatment of fissure in ano. Med J Aust 2:461–462, 487

Jensen SL, Lund F, Nielsen OV, Tange G (1984) Lateral subcutaneous sphincterotomy versus anal dilatation in the treatment of fissure in ano in outpatients: a prospective randomised study. Br Med J (Clin Res Ed) 289:528–530

Fischer M, Hamelmann H (1978) [Dilatation or sphincterotomy as the treatment of primary-chronic fissure in ano. Results of a random, clinical study after 2–3 years]. Chirurg 49:215–218

Giebel GD, Horch R (1989) Treatment of anal fissure: a comparison of three different forms of therapy. Nippon Geka Hokan 58:126–133

Oueidat D (1999) A comparative study in anal fissure treatment. J Med Liban 47:164–168

Nelson RL (1999) Meta-analysis of operative techniques for fissure-in-ano. Dis Colon Rectum 42:1424–1428; discussion 1428–1431

Nelson R (2005) Operative procedures for fissure in ano. Cochrane Database Syst Rev:CD002199

Bekheit F (1974) Anal fissure; comparative study of various lines of treatment with 125 cases. J Egypt Med Assoc 57:365

Speakman CT, Burnett SJ, Kamm MA, Bartram CI (1991) Sphincter injury after anal dilatation demonstrated by anal endosonography. Br J Surg 78:1429–1430

Nielsen MB, Rasmussen OO, Pedersen JF, Christiansen J (1993) Risk of sphincter damage and anal incontinence after anal dilatation for fissure-in-ano. An endosonographic study. Dis Colon Rectum 36:677–680

Boschetto S, Giovannone M, Tosoni M, Barberani F (2004) Hydropneumatic anal dilation in conservative treatment of chronic anal fissure: clinical outcomes and randomized comparison with topical nitroglycerin. Tech Coloproctol 8:89–92; discussion 92–83

Lestar B, Penninckx F, Kerremans R (1987) Anal dilatation. Int J Colorectal Dis 2:167–168

Poisson J (1977) [Anal fissure]. Can J Surg 20:417–421

Abcarian H (1980) Surgical correction of chronic anal fissure: results of lateral internal sphincterotomy vs. fissurectomy—midline sphincterotomy. Dis Colon Rectum 23:31–36

Notaras MJ (1971) The treatment of anal fissure by lateral subcutaneous internal sphincterotomy—a technique and results. Br J Surg 58:96–100

Hoffmann DC, Goligher JC (1970) Lateral subcutaneous internal sphincterotomy in treatment of anal fissure. Br Med J 3:673–675

Lewis TH, Corman ML, Prager ED, Robertson WG (1988) Long-term results of open and closed sphincterotomy for anal fissure. Dis Colon Rectum 31:368–371

Kortbeek JB, Langevin JM, Khoo RE, Heine JA (1992) Chronic fissure-in-ano: a randomized study comparing open and subcutaneous lateral internal sphincterotomy. Dis Colon Rectum 35:835–837

Wiley M, Day P, Rieger N, Stephens J, Moore J (2004) Open vs. closed lateral internal sphincterotomy for idiopathic fissure-in-ano: a prospective, randomized, controlled trial. Dis Colon Rectum 47:847–852

Arroyo A, Perez F, Serrano P, Candela F, Calpena R (2004) Open versus closed lateral sphincterotomy performed as an outpatient procedure under local anesthesia for chronic anal fissure: prospective randomized study of clinical and manometric longterm results. J Am Coll Surg 199:361–367

Garcia-Aguilar J, Belmonte C, Wong WD, Lowry AC, Madoff RD (1996) Open vs. closed sphincterotomy for chronic anal fissure: long-term results. Dis Colon Rectum 39:440–443

Corman ML (1990) Anal fissure. In: Corman ML (ed) Colon and rectal surgery. JB Lippincott, Philadelphia, pp 115–117

Keighley MR (1993) Fissure in ano. In: Keighley MR, Williams NS (eds) Surgery of the anus, rectum and colon. WB Saunders, Philadelphia, pp 364–386

Timmcke AE, Hicks TC (1996) Fissure-in-ano. In: Zuidema GD, Condon RE (eds) Shackleford’s surgery of the alimentary tract. WB Saunders, Philadelphia, pp 322–329

Littlejohn DR, Newstead GL (1997) Tailored lateral sphincterotomy for anal fissure. Dis Colon Rectum 40: 1439–1442

Mentes BB, Ege B, Leventoglu S, Oguz M, Karadag A (2005) Extent of lateral internal sphincterotomy: up to the dentate line or up to the fissure apex? Dis Colon Rectum 48:365–370

Garcea G, Sutton C, Mansoori S, Lloyd T, Thomas M (2003) Results following conservative lateral sphincteromy for the treatment of chronic anal fissures. Colorectal Dis 5:311–314

Mentes BB, Irkorucu O, Akin M, Leventoglu S, Tatlicioglu E (2003) Comparison of botulinum toxin injection and lateral internal sphincterotomy for the treatment of chronic anal fissure. Dis Colon Rectum 46:232–237

Rudd WW (1975) Lateral subcutaneous internal sphincterotomy for chronic anal fissure, an outpatient procedure. Dis Colon Rectum 18:319–323

Nyam DC, Pemberton JH (1999) Long-term results of lateral internal sphincterotomy for chronic anal fissure with particular reference to incidence of fecal incontinence. Dis Colon Rectum 42:1306–1310

Zbar AP, Aslam M, Allgar V (2000) Faecal incontinence after internal sphincterotomy for anal fissure. Tech Coloproctol 4:25–28

Rotholtz NA, Bun M, Mauri MV, Bosio R, Peczan CE, Mezzadri NA (2005) Long-term assessment of fecal incontinence after lateral internal sphincterotomy. Tech Coloproctol 9:115–118

Brown CJ, Dubreuil D, Santoro L, Liu M, O’Connor BI, McLeod RS (2007) Lateral internal sphincterotomy is superior to topical nitroglycerin for healing chronic anal fissure and does not compromise long-term fecal continence: six-year follow-up of a multicenter, randomized, controlled trial. Dis Colon Rectum 50:442–448

Casillas S, Hull TL, Zutshi M, Trzcinski R, Bast JF, Xu M (2005) Incontinence after a lateral internal sphincterotomy: are we underestimating it? Dis Colon Rectum 48:1193–1199

Sultan AH, Kamm MA, Nicholls RJ, Bartram CI (1994) Prospective study of the extent of internal anal sphincter division during lateral sphincterotomy. Dis Colon Rectum 37:1031–1033

Rosa G, Lolli P, Piccinelli D et al (2005) Calibrated lateral internal sphincterotomy for chronic anal fissure. Tech Coloproctol 9:127–131; discussion 131–122

Garcia-Aguilar J, Belmonte Montes C, Perez JJ, Jensen L, Madoff RD, Wong WD (1998) Incontinence after lateral internal sphincterotomy: anatomic and functional evaluation. Dis Colon Rectum 41:423–427

Madoff RD, Steele SR (2006) Anorectal manometry and anal fissure treatment: authors’ reply. Aliment Pharmacol Ther 24:1652

Mentes BB, Tezcaner T, Yilmaz U, Leventoglu S, Oguz M (2006) Results of lateral internal sphincterotomy for chronic anal fissure with particular reference to quality of life. Dis Colon Rectum 49:1045–1051

Ortiz H, Marzo J, Armendariz P, De Miguel M (2005) Quality of life assessment in patients with chronic anal fissure after lateral internal sphincterotomy. Br J Surg 92:881–885

Di Castro A, Biancari F, D’Andrea V, Caviglia A (1997) Fissurectomy with posterior midline sphincterotomy and anoplasty (FPSA) in the management of chronic anal fissures. Surg Today 27:975–978

Engel AF, Eijsbouts QA, Balk AG (2002) Fissurectomy and isosorbide dinitrate for chronic fissure in ano not responding to conservative treatment. Br J Surg 89:79–83

Meier zu Eissen J (2001) [Chronic anal fissure, therapy]. Kongressbd Dtsch Ges Chir Kongr 118:654–656

Lindsey I, Cunningham C, Jones OM, Francis C, Mortensen NJ (2004) Fissurectomy-botulinum toxin: a novel sphincter-sparing procedure for medically resistant chronic anal fissure. Dis Colon Rectum 47:1947–1952

Hsu TC, MacKeigan JM (1984) Surgical treatment of chronic anal fissure. A retrospective study of 1753 cases. Dis Colon Rectum 27:475–478

Pelta K, Davis K, Armstrong D (2007) Subcutaneous fissurotomy: a novel sphincter-saving procedure for chronic fissure-in-ano. Dis Colon Rectum 50:738 (abstract)

Ruiz-Moreno F (1968) Sliding mucocutaneous flap for the treatment of anal ulcer. Dis Colon Rectum 11:285–288

Leong AF, Seow-Choen F (1995) Lateral sphincterotomy compared with anal advancement flap for chronic anal fissure. Dis Colon Rectum 38:69–71

Nyam DC, Wilson RG, Stewart KJ, Farouk R, Bartolo DC (1995) Island advancement flaps in the management of anal fissures. Br J Surg 82:326–328

Jonas M, Scholefield JH (2001) Anal fissure. Gastroenterol Clin North Am 30:167–181

Fung HL (1993) Clinical pharmacology of organic nitrates. Am J Cardiol 72:9C–13C; discussion 14C–15C

Davies MG, Fulton GJ, Hagen PO (1995) Clinical biology of nitric oxide. Br J Surg 82:1598–1610

Ahlner J, Andersson RG, Torfgard K, Axelsson KL (1991) Organic nitrate esters: clinical use and mechanisms of actions. Pharmacol Rev 43:351–423

Feelisch M (1991) The biochemical pathways of nitric-oxide formation from nitrovasodilators — appropriate choice of exogenous NO donors and aspects of preparation and handling of aqueous NO solutions. J Cardiovasc Pharmacol 17:S25–S33

Fung HL (1992) Do nitrates differ? Br J Clin Pharmacol 34[Suppl 1]:5S–9S

Bogaert MG (1987) Clinical pharmacokinetics of glyceryl trinitrate following the use of systemic and topical preparations. Clin Pharmacokinet 12:1–11

Jonas M, Barrett DA, Shaw PN, Scholefield JH (2001) Systemic levels of glyceryl trinitrate following topical application to the anoderm do not correlate with the measured reduction in anal pressure. Br J Surg 88:1613–1616

L’Hopital F, Michelland O, Lunaud B, Bommelaere G (1990) Constipation et hypertonie du sphincter interne de l’anus: response sphincterienne a l’administration sub-linguale de 0.40 mg de Natispray. Gastroenterol Clin Biol 14:268

Guillemot F, Lone YC, Leroi H, Lamblin MD, Cortot A (1992) Nitroglycerin in situ reduces upper anal canal pressure. Dig Dis Sci 37:155

Guillemot F, Leroi H, Lone YC, Rousseau CG, Lamblin MD, Cortot A (1993) Action of in situ nitroglycerin on upper anal canal pressure of patients with terminal constipation. A pilot study. Dis Colon Rectum 36:372–376

Lund JN, Armitage NC, Scholefield JH (1996) Use of glyceryl trinitrate ointment in the treatment of anal fissure. Br J Surg 83:776–777

Gorfine SR (1995) Treatment of benign anal disease with topical nitroglycerin. Dis Colon Rectum 38:453–456; discussion 456–457

Gorfine SR (1995) Topical nitroglycerin therapy for anal fissures and ulcers. N Engl J Med 333:1156–1157

Lund JN, Scholefield JH (1997) A randomised, prospective, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in treatment of anal fissure. Lancet 349:11–14

Nelson R (2006) Non surgical therapy for anal fissure. Cochrane Database Syst Rev:CD003431

Parellada C (2004) Randomized, prospective trial comparing 0.2 percent isosorbide dinitrate ointment with sphincterotomy in treatment of chronic anal fissure: a two-year follow-up. Dis Colon Rectum 47:437–443

Loder PB, Kamm MA, Nicholls RJ, Phillips RK (1994) ’Reversible chemical sphincterotomy’ by local application of glyceryl trinitrate. Br J Surg 81:1386–1389

Altomare DF, Rinaldi M, Milito G et al (2000) Glyceryl trinitrate for chronic anal fissure—healing or headache? Results of a multicenter, randomized, placebo-controled, double-blind trial. Dis Colon Rectum 43:174–179; discussion 179–181

Azarnoff DL, Lee JC, Lee C, Chandler J, Karlin D (2007) Quality of extemporaneously compounded nitroglycerin ointment. Dis Colon Rectum 50:509–516

Scholefield JH, Bock JU, Marla B et al (2003) A dose finding study with 0.1%, 0.2%, and 0.4% glyceryl trinitrate ointment in patients with chronic anal fissures. Gut 52:264–269

Bailey HR, Beck DE, Billingham RP et al (2002) A study to determine the nitroglycerin ointment dose and dosing interval that best promote the healing of chronic anal fissures. Dis Colon Rectum 45:1192–1199

Zuberi BF, Rajput MR, Abro H, Shaikh SA (2000) A randomized trial of glyceryl trinitrate ointment and nitroglycerin patch in healing of anal fissures. Int J Colorectal Dis 15:243–245

De Nardi P, Ortolano E, Radaelli G, Staudacher C (2006) Comparison of glycerine trinitrate and botulinum toxin-a for the treatment of chronic anal fissure: long-term results. Dis Colon Rectum 49:427–432

Brisinda G, Maria G, Bentivoglio AR, Cassetta E, Gui D, Albanese A (1999) A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure. N Engl J Med 341:65–69

Cook TA, Humphreys MM, McCMortensen NJ (1999) Oral nifedipine reduces resting anal pressure and heals chronic anal fissure. Br J Surg 86:1269–1273

Fenton C, Wellington K, Easthope SE (2006) 0.4% nitroglycerin ointment: in the treatment of chronic anal fissure pain. Drugs 66:343–349

Oettle GJ (1997) Glyceryl trinitrate vs. sphincterotomy for treatment of chronic fissure-in-ano: a randomized, controlled trial. Dis Colon Rectum 40:1318–1320

Evans J, Luck A, Hewett P (2001) Glyceryl trinitrate vs. lateral sphincterotomy for chronic anal fissure: prospective, randomized trial. Dis Colon Rectum 44:93–97

Richard CS, Gregoire R, Plewes EA et al (2000) Internal sphincterotomy is superior to topical nitroglycerin in the treatment of chronic anal fissure: results of a randomized, controlled trial by the Canadian Colorectal Surgical Trials Group. Dis Colon Rectum 43:1048–1057; discussion 1057–1048

Libertiny G, Knight JS, Farouk R (2002) Randomised trial of topical 0.2% glyceryl trinitrate and lateral internal sphincterotomy for the treatment of patients with chronic anal fissure: long-term follow-up. Eur J Surg 168:418–421

Mishra R, Thomas S, Maan MS, Hadke NS (2005) Topical nitroglycerin versus lateral internal sphincterotomy for chronic anal fissure: prospective, randomized trial. ANZ J Surg 75:1032–1035

Graziano A, Svidler Lopez L, Lencinas S, Masciangioli G, Gualdrini U, Bisisio O (2001) Long-term results of topical nitroglycerin in the treatment of chronic anal fissures are dis-appointing. Tech Coloproctol 5:143–147

Chrysos E, Xynos E, Tzovaras G, Zoras OJ, Tsiaoussis J, Vassilakis SJ (1996) Effect of nifedipine on rectoanal motility. Dis Colon Rectum 39:212–216

Cook TA, Brading AF, Mortensen NJ (1999) Effects of nifedipine on anorectal smooth muscle in vitro. Dis Colon Rectum 42:782–787

Antropoli C, Perrotti P, Rubino M et al (1999) Nifedipine for local use in conservative treatment of anal fissures: preliminary results of a multicenter study. Dis Colon Rectum 42:1011–1015

Carapeti EA, Kamm MA, Phillips RK (2000) Topical diltiazem and bethanechol decrease anal sphincter pressure and heal anal fissures without side effects. Dis Colon Rectum 43:1359–1362

Knight JS, Birks M, Farouk R (2001) Topical diltiazem ointment in the treatment of chronic anal fissure. Br J Surg 88:553–556

Griffin N, Acheson AG, Jonas M, Scholefield JH (2002) The role of topical diltiazem in the treatment of chronic anal fissures that have failed glyceryl trinitrate therapy. Colorectal Dis 4:430–435

Jonas M, Speake W, Scholefield JH (2002) Diltiazem heals glyceryl trinitrate-resistant chronic anal fissures: a prospective study. Dis Colon Rectum 45:1091–1095

DasGupta R, Franklin I, Pitt J, Dawson PM (2002) Successful treatment of chronic anal fissure with diltiazem gel. Colorectal Dis 4:20–22

Mustafa NA, Cengiz S, Turkyilmaz S, Yucel Y (2006) Comparison of topical glyceryl trinitrate ointment and oral nifedipine in the treatment of chronic anal fissure. Acta Chir Belg 106:55–58

Ansaloni L, Bernabe A, Ghetti R, Riccardi R, Tranchino RM, Gardini G (2002) Oral lacidipine in the treatment of anal fissure. Tech Coloproctol 6:79–82

Agaoglu N, Cengiz S, Arslan MK, Turkyilmaz S (2003) Oral nifedipine in the treatment of chronic anal fissure. Dig Surg 20:452–456

Ho KS, Ho YH (2005) Randomized clinical trial comparing oral nifedipine with lateral anal sphincterotomy and tailored sphincterotomy in the treatment of chronic anal fissure. Br J Surg 92:403–408

Montecucco C, Molgo J (2005) Botulinal neurotoxins: revival of an old killer. Curr Opin Pharmacol 5:274–279

Dolly JO, Aoki KR (2006) The structure and mode of action of different botulinum toxins. Eur J Neurol 13[Suppl 4]:1–9

Runfola M, Di Mugno M, Balletta A, Magalini SC, Gui D (2006) Antinociceptive effect of botulinum toxin: an added value to chemical sphincterotomy in anal fissure? Dis Colon Rectum 49:1078–1079

Jones OM, Brading AF, Mortensen NJ (2004) Mechanism of action of botulinum toxin on the internal anal sphincter. Br J Surg 91:224–228

Jost WH, Schimrigk K (1993) Use of botulinum toxin in anal fissure. Dis Colon Rectum 36:974

Maria G, Cassetta E, Gui D, Brisinda G, Bentivoglio AR, Albanese A (1998) A comparison of botulinum toxin and saline for the treatment of chronic anal fissure. N Engl J Med 338:217–220

Fruehauf H, Fried M, Wegmueller B, Bauerfeind P, Thumshirn M (2006) Efficacy and safety of botulinum toxin a injection compared with topical nitroglycerin ointment for the treatment of chronic anal fissure: a prospective randomized study. Am J Gastroenterol 101:2107–2112

Lysy J, Israelit-Yatzkan Y, Sestiery-Ittah M, Weksler-Zangen S, Keret D, Goldin E (2001) Topical nitrates potentiate the effect of botulinum toxin in the treatment of patients with refractory anal fissure. Gut 48:221–224

Jost WH (1997) One hundred cases of anal fissure treated with botulin toxin: early and long-term results. Dis Colon Rectum 40:1029–1032

Arroyo A, Perez F, Serrano P, Candela F, Lacueva J, Calpena R (2005) Surgical versus chemical (botulinum toxin) sphincterotomy for chronic anal fissure: long-term results of a prospective randomized clinical and manometric study. Am J Surg 189:429–434

Minguez M, Herreros B, Espi A et al (2002) Long-term follow-up (42 months) of chronic anal fissure after healing with botulinum toxin. Gastroenterology 123:112–117

Massoud BW, Mehrdad V, Baharak T, Alireza Z (2005) Botulinum toxin injection versus internal anal sphincterotomy for the treatment of chronic anal fissure. Ann Saudi Med 25:140–142

Iswariah H, Stephens J, Rieger N, Rodda D, Hewett P (2005) Randomized prospective controlled trial of lateral internal sphincterotomy versus injection of botulinum toxin for the treatment of idiopathic fissure in ano. ANZ J Surg 75:553–555

Garrido R, Lagos N, Lattes K et al (2005) Gonyautoxin: new treatment for healing acute and chronic anal fissures. Dis Colon Rectum 48:335–340; discussion 340–333

Gui D, Cassetta E, Anastasio G, Bentivoglio AR, Maria G, Albanese A (1994) Botulinum toxin for chronic anal fissure. Lancet 344:1127–1128

Jost WH, Schrank B (1999) Repeat botulin toxin injections in anal fissure: in patients with relapse and after insufficient effect of first treatment. Dig Dis Sci 44:1588–1589

Gonzalez Carro P, Perez Roldan F, Legaz Huidobro ML, Ruiz Carrillo F, Pedraza Martin C, Saez Bravo JM (1999) [The treatment of anal fissure with botulinum toxin]. Gastroenterol Hepatol 22:163–166

Fernandez Lopez F, Conde Freire R, Rios Rios A, Garcia Iglesias J, Cainzos Fernandez M, Potel Lesquereux J (1999) Botulinum toxin for the treatment of anal fissure. Dig Surg 16:515–518

Minguez M, Melo F, Espi A et al (1999) Therapeutic effects of different doses of botulinum toxin in chronic anal fissure. Dis Colon Rectum 42:1016–1021

Brown SR, Matabudul Y, Shorthouse AJ (2006) A second case of long-term incontinence following Botulinum toxin injection for anal fissure. Colorectal Dis 8:452–453

Smith M, Frizelle F (2004) Long-term faecal incontinence following the use of botulinum toxin. Colorectal Dis 6:526–527

Gosselink MP, Darby M, Zimmerman DD, Gruss HJ, Schouten WR (2005) Treatment of chronic anal fissure by application of L-arginine gel: a phase II study in 15 patients. Dis Colon Rectum 48:832–837

Prins HA, Gosselink MP, Mitales LE et al (2005) The effect of oral administration of L-arginine on anal resting pressure and anodermal blood flow in healthy volunteers. Tech Coloproctol 9:229–232; discussion 232–223

Muthukumarassamy R, Robinson SS, Sarath SC, Raveendran R (2005) Treatment of anal fissures using a combination of minoxidil and lignocaine: a randomized, double-blind trial. Indian J Gastroenterol 24:158–160

Al-Hilli Z, Pritchard R, Roche-Nagle G, Deasy J, McNamara DA (2006) Nicorandil related anal ulcer. Ir J Med Sci 175:62–63

Rival AL, Allombert-Blaise C, Ly A, Grandjean JP, Faure M, Claudy A (2006) [Nicorandil-associated anal ulceration]. Ann Dermatol Venereol 133:781–783

Watson A, Al-Ozairi O, Fraser A, Loudon M, O’Kelly T (2002) Nicorandil associated anal ulceration. Lancet 360:546–547

Toquero L, Briggs CD, Bassuini MM, Rochester JR (2006) Anal ulceration associated with nicorandil: case series and review of the literature. Colorectal Dis 8:717–720

Yamato S, Rattan S (1990) Role of alpha adrenoceptors in opossum internal anal sphincter. J Clin Invest 86:424–429

Pitt J, Craggs MM, Henry MM, Boulos PB (2000) Alpha-1 adrenoceptor blockade: potential new treatment for anal fissures. Dis Colon Rectum 43:800–803

Pitt J, Dawson PM, Hallan RI, Boulos PB (2001) A double-blind randomized placebo-controlled trial of oral indoramin to treat chronic anal fissure. Colorectal Dis 3:165–168

Boolell M, Allen MJ, Ballard SA et al (1996) Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction. Int J Impot Res 8:47–52

Ito T, Ozawa K, Shimada K (2007) Current drug targets and future therapy of pulmonary arterial hypertension. Curr Med Chem 14:719

Lichtenstein JR (2003) Use of sildenafil citrate in Raynaud’s phenomenon: comment on the article by Thompson et al. Arthritis Rheum 48:282–283; author reply 283

Heymann WR (2006) Sildenafil for the treatment of Raynaud’s phenomenon. J Am Acad Dermatol 55:501–502

Khan RN, Hamoud H, Warren A, Wong LF, Arulkumaran S (2004) Relaxant action of sildenafil citrate (Viagra) on human myometrium of pregnancy. Am J Obstet Gynecol 191:315–321

Torrabadella L, Salgado G, Burns RW, Berman IR (2004) Manometric study of topical sildenafil (Viagra) in patients with chronic anal fissure: sildenafil reduces anal resting tone. Dis Colon Rectum 47:733–738

Aygen E, Camci C, Durmus AS et al (2005) Inhibitory effects of sildenafil citrate on the tonus of isolated dog internal anal sphincter. Dis Colon Rectum 48:1615–1619

Ballester C, Sarria B, Garcia-Granero E, Morcillo EJ, Lledo S, Cortijo J (2007) Relaxation of the isolated human internal anal sphincter by sildenafil. Br J Surg 94:894–902

De Godoy MA, Dunn S, Rattan S (2004) Evidence for the role of angiotensin II biosynthesis in the rat internal anal sphincter tone. Gastroenterology 127:127–138

De Godoy MA, Rattan S (2005) Autocrine regulation of internal anal sphincter tone by renin-angiotensin system: comparison with phasic smooth muscle. Am J Physiol Gastrointest Liver Physiol 289:G1164–G1175

Khaikin (2007) Topical captopril cream: a new treatment for anal fissure? The first human study. Dis Colon Rectum 50:747 (abstract)

Madoff RD, Fleshman JW (2003) AGA technical review on the diagnosis and care of patients with anal fissure. Gastroenterology 124:235–245

Orsay C, Rakinic J, Perry WB et al (2004) Practice parameters for the management of anal fissures (revised). Dis Colon Rectum 47:2003–2007

CKS (2005) Anal Fissure (PRODIGY guidance). Clinical Knowledge Summaries Service. www.cks.library.nhs.uk/anal_fissure [Accessed: June 2007]

Lund JN, Nystrom PO, Coremans G et al (2006) An evidence-based treatment algorithm for anal fissure. Tech Coloproctol 10:177–180

Chronic anal fissure hospital episode statistics, Department of Health. (available at http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=192 )