Current evidence and new trends in anal fissure treatment

An anal fissure is a benign and painful ulcer extending from the pectinate line to the anal margin. It leads to an increase in the resting pressure of the internal anal sphincter and the pressure within the anal canal, resulting in local ischemia and impaired wound healing. Anal fissures are mostly located in the posterior midline. They are primarily caused by local trauma to the anoderm, often due to the passage of hard stools, irritation from diarrhea, or anorectal surgery. For both acute and chronic anal fissures, several treatment options are available, and surgery typically reserved as a second-line option. Recent trends in first-line therapy prefer calcium channel blockers (CCBs) over topical glyceryl trinitrate (GTN), as they offer similar healing rates but are associated with fewer side effects and better patient's compliance. Lateral internal sphincterotomy (LIS) remains the gold-standard surgical treatment for this condition. Additionally, emerging therapies, such as platelet-rich plasma (PRP) application, adipose-derived regenerative cells (ADRCs), and percutaneous tibial nerve stimulation (PTNS), have shown promising results and they are gaining attention as potential alternatives for managing chronic anal fissures. The present narrative review aims to provide a comprehensive overview of current therapeutic approaches for anal fissures, evaluating their effectiveness in promoting healing and comparing them with guideline-based recommendations.