[Sphincter-sparing treatment of anal fissure]

Surgical treatment of the anal fissure is associated with unreasonably high risks of delayed development of fecal incontinence to gas or liquid stool. Standardized sphincter-preserving therapy, based on the pharmacological reduction of increased internal anal sphincter tone (chemical sphincterotomy) allows to improve significantly the results of the non-surgical approach of treating one of the most common pathology in proctological practice. Our work presents a retrospective analysis of the treatment of 295 patients with anal fissure treated with diltiazem ointment, nifedipine ointment, nitroglycerin ointment and botulinum toxin A. Significant improvement or disappearance of complaints was noted in 84% of patients. The use of botulinum toxin A was successfull in 10 out of 11 patients without the need of surgical intervention. High efficiency (91% of patients) of the sphincter-preserving approach with a significant decrease in the need for aggressive surgical manipulation allows to decrease sphincterotomy rate and reduces the risk of delayed fecal incontinence.