Standards of anal fissure management in Europe and the United States

Anal fissure is the second most common proctological disorder after haemorrhoids. The majority of researchers agree that conservative treatment should be the first stage of anal fissure management. The procedures used for the treatment of anal fissure are the biggest subject of disagreement. The aim of this article is to review and compare thedifferences in the methods of anal fissure management in certain European countries and in the United States. Anal fissure treatment varies between different countries. In many algorithms, fissurectomy combined with anal skin advancement flap reconstruction is listed as the first treatment option. Posterior sphincterotomy, which is frequently performed in Poland, is not included in any of the algorithms quoted in this paper; lateral sphincterotomy is preferred instead. No algorithm recommends manual anal dilation, which is consistent with our observations that this procedure is associated with uncontrolled tearing of sphincter muscle fibres and a high risk of incontinence. This article reviews and compares the differences in the methods of anal fissure treatment in certain European countries and in the United States.