Attitudes to the treatment of chronic anal fissure in ano after failed medical treatment

Objective The treatment of chronic fissure may be medical or surgical. Indications for assessment, which is the better treatment and under what circumstances, are vital for the appropriate management. The aim of the study was to assess the management of this condition by an expert group of surgeons. Methods Consultant members of the Association of Coloproctology of Great Britain and Ireland (n = 452) were approached and requested to answer a preset multiple‐choice questionnaire. The questionnaire was designed to assess their management strategy and their approach to investigation and treatment under different clinical situations. Results The overall response was 78% (n = 356). Medical treatment was the first line treatment in 95% of the responders. Lateral anal sphincterotomy without pre‐operative endoanal ultrasound and/or anorectal physiology was performed by 57%. Anal dilatation was performed selectively by 36% but only 35% of these would perform a pre‐operative endoanal ultrasound or anorectal physiology. Conclusion In the selected group of clinicians lateral anal sphincterotomy remains the procedure of choice in both sexes. Pre‐operative assessment using endoanal ultrasound and anorectal physiology is used selectively especially in postpartum women. Anal dilatation remains a subjective procedure and though used selectively, is performed without pre‐operative endoanal ultrasound and/or anorectal physiology in majority of cases.