The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure.
Antonio BrillantinoAdolfo RenziPasquale TalentoFrancesca IacobellisLuigi BruscianoLuigi MonacoDomenico IzzoAlfredo GiordanoMichele PintoCorrado FantiniMarcello GasparriniMichele Schiano Di VisconteFrancesca MilazzoGiovanni FerreriAndrea BrainiUmberto CocozzaMassimo PezzatiniValeria GianfredaAlberto Di LeoVincenzo LandolfiUmberto FavettaSergio AgradiGiovanni MarinoMassimilano VarrialeMassimo MongardiniClaudio Eduardo Fernando Antonio PaganoRiccardo Brachet ContulNando GalleseGiampiero UcchinoMichele D'AmbraRoberto RizzatoGiacomo SarzoBruno MasciFrancesca Da PozzoSimona AscanelliFabrizio ForoniAlessio PalumboPatrizia LiguoriAngela PezzollaLuigi MaranoAntonio CapomagiEugenio CudazzoFrancesca BabicCarmelo GeremiaAlessandro BussottiMario CicconiAntonia Di SarnoFederico Maria MongardiniAntonio BresciaLeonardo LenisaMassimiliano MistrangeloMaria Laura Sandoval SoteloLuciano VicenzoAntonio LongoLudovico DocimoPublished in: BMC surgery (2023)
In patients with acute anal fissure the medical therapy with dietary and behavioral norms is indicated. In the chronic phase of disease, the conservative treatment with topical 0.3% nifedipine plus 1.5% lidocaine or nitrates may represent the first-line therapy, eventually associated with ointments with film-forming, anti-inflammatory and healing properties such as Propionibacterium extract gel. In case of first-line treatment failure, the surgical strategy (internal sphincterotomy or fissurectomy with flap), may be guided by the clinical findings, eventually supported by endoanal ultrasound and anal manometry.