Global Management of Anal Fissure: Results from the ISUCRS 2022 Snapshot Audit

Background: Anal fissure is a common benign condition, yet its management varies widely. The International Society of University Colon and Rectal Surgeons (ISUCRS) conducted a global snapshot audit to describe contemporary real-world management patterns. Methods: During a 2-week period (June-July 2022), 56 colorectal surgeons from 21 countries prospectively recorded data for consecutive patients presenting with anal fissure. Exclusion criteria included inflammatory bowel disease, pregnancy or lactation, psychiatric disorders, immunosuppression, and anorectal sepsis. Acute fissure was defined as symptoms <6 weeks without sentinel pile; chronic fissure as >6 weeks or fibrotic edges/sentinel pile. The "Cure" was defined as complete symptom resolution or healed fissure on clinical or tele-follow-up. Results: A total of 302 patients were analyzed (mean age 41 ± 13 years; 52% women). Acute fissure was present in 42%, chronic in 58%. Conservative treatment (dietary advice, stool-softeners, topical agents, botulin toxin, pelvic-floor training) was initiated in 236 (78%) patients, while 66 (22%) underwent surgery, most commonly lateral internal sphincterotomy (LIS). At 8-week follow-up, 73% of patients treated conservatively and 88% of those treated surgically achieved clinical resolution of symptoms or healed fissure. Conclusions: Global management of anal fissure remains heterogeneous. Most surgeons favor conservative measures such as first-line therapy, reserving LIS for chronic or refractory fissures. Standardized definitions and outcome reporting are needed to improve comparability and guide future international guidelines.