Comparison among Different Methods in Treatment of Anal Fissures

Abstract

Background: Anal fissures represent one of the common diseases that affect the anorectal area. Patients present with painful tears in this area that finally result in chronic discomfort and pain. Multiple surgical procedures were applied in the treatment of chronic anal fissures, but the optimal technique remains unclear.

Aims of the study: This study aimed to perform an assessment of three surgical techniques used in the treatment of chronic anal fissures regarding fissure healing, pain remission, and related complications.

Patients and methods: The study was performed in the period from November 2023 to April 2025, it consists of 180 patients with chronic anal fissures. Random distribution of patients into three treatment groups: Group A (Topical Nifedipine), Group B (Laser Therapy), and Group C (Lateral Internal Sphincterotomy). These procedures were evaluated using three methods of assessment: pain remission, fissure healing, and complications at period intervals of one, two, four, and six weeks post-treatment in addition to long-term follow- up through six and twelve months intervals.

Results: Laser therapy represented the most effective treatment procedure. In this procedure, the pain remission ratio was 96.5% then lateral internal sphincterotomy 90.7% and lastly topical Nifedipine 75%. The highest rate of fissure healing after six weeks was performed in Laser therapy (the ratio was 94.8% while surgery was 82.9% and Nifedipine 67.3%. The fewest complications were found in laser method with a low recurrence rate of 3.6%.

Conclusion: The study revealed that laser therapy technique represents the most effective and safest method of treatment for chronic anal fissures because it had rapid pain relief, rapid healing and few complications.