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Surgeons’ practice and preferences for the anal fissure treatment: results from an international survey

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Abstract

The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons’ practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants’ demographics and, 27 questions about their clinical practice. Based on the specialty (general surgeon and colorectal surgeon), obtained data were divided and compared between two groups. Five-hundred surgeons were included (321 general and 179 colorectal surgeons). For both groups, duration of symptoms for at least 6 weeks is the most important factor for AF diagnosis (30.6%). Type of AF (acute vs chronic) is the most important factor which guide the therapeutic plan (44.4%). The first treatment of choice for acute AF is ointment application for both groups (59.6%). For the treatment of chronic AF, this data is confirmed by colorectal surgeons (57%), but not by the general surgeons who prefer the lateral internal sphincterotomy (LIS) (31.8%) (p = 0.0001). Botulin toxin injection is most performed by colorectal surgeons (58.7%) in comparison to general surgeons (20.9%) (p = 0.0001). Anal flap is mostly performed by colorectal surgeons (37.4%) in comparison to general surgeons (28.3%) (p = 0.0001). Fissurectomy alone is statistically significantly most performed by general surgeons in comparison to colorectal surgeons (57.9% and 43.6%, respectively) (p = 0.0020). This analysis provides useful information about the clinical practice for the management of a debated topic such as AF treatment. Shared guidelines and consensus especially focused on operative management are required to standardize the treatment and to improve postoperative results.

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Acknowledgments

Anal Fissure Collaborative Group: Bourguiba Mohamed Aboulkacem, Tewodros Abule, Mikhail Agapov, Ferdinando Agresta, Alberto Aiolfi, Abdulahad Al-Ameri, Mehmet Ali Koç, Vusal Aliyev, Abdullah Alkhuzaie, Michele Ammendola, Giorgio Ammerata, Marco Anania, Jacopo Andreuccetti, Elissavet Anestiadou, Genna Aníbal, Alfredo Annicchiarico, Pietro Anoldo, Amedeo Antonelli, Giovanni Aprea, Francesco Arcanà, Massimiliano Ardu, Alberto Arezzo, Giulio Argenio, Gabriela Arroyo Murillo, Goran Augustin, Andrea Avanzolini, Pasquale Avella, Erman Aytac, Alessandro Baggi, Gian Luca Baiocchi, Edoardo Baldini, Ioannis Baloyiannis, Christos Bartsokas, Ernesto Barzola, Luigi Basso, Hazem Beji, Vittoria Bellato, Mehmet Sah Benk, Ilaria Benzoni, Nicolae-Iustin Berevoescu, Christophe R. Berney, Pankaj Bharambe, Alan Biloslavo, Francisco Blanco Antona, Florin Bobirca, Jesús Bollo, D Bona, Dario Bono, Andrea Bondurri, Luca Domenico Bonomo, Andrea Bottari, Corrado Bottini, Konstantinos Bouchagier, Giuseppe Brisinda, Joris P. Bulte, Matteo Bussotti, Giacomo Calini, Valentin Calu, Marco Calussi, Roberto Cammarata, Giuseppe Candilio, Francesco Cantarella, Filippo Caponnetto, Sonia Cappelli, Fabio Capra, Marianna Capuano, Filippo Carannante, Ludovico Carbone, Luca Cardinali, Maria Cariati, Marco Caricato, Francesco Maria Carrano, Milagros Carrasco, Francesco Carrino, Gianmaria Casoni Pattacini, Gianluca Cassese, Antonio Castaldi, Flavia Cavicchi, Jose Mª Fernández Cebrián, Carlos Cerdán-Santacruz, Giovanni Cestaro, Vijitha Chandima Halahakoon, Mohamed Ali Chaouch, Dimitrios Chatziisaak, Vikram Chaturvedi, Antonella Chessa, Maria Michela Chiarello, Andrei Chitul, Angeliki Chorti, Christos Chouliaras, Prokopis Christodoulou, Pasquale Cianci, Matteo Cinquepalmi, Juan Cintas Catena, Tommaso Cipolat Mis, Bruno Cirillo, Ilaria Clementi, Marco Clementi, Daniel Clerc, Francesco Cobellis, Luigi Cobellis, Enrique Colás-Ruiz, Renan Carlo Colombari Monteiro, Francesco Colombo, Diego Coletta, Alessandro Coppola, Diletta Corallino, Stefano Costa, Maurizio Costantini, Nicola Cracco, Vladica Cuk, Giuseppe Curro, Nathan J Curtis, Fabrizio D'Acapito, Dragomir Dardanov, Justin Davies, Christopher Dawoud, Georgia Dedemadi, Giacomo Deiro, Michele De Capua, Antonio De Leonardis, Celeste Del Basso, Samir Delibegovi, Anil Demir, Semra Demirli Atici, Sara D'Errico, Michele De Rosa, Belinda De Simone, Veronica De Simone, Agnese Dezi, Maria Manuel Diez Alonso, Anthony Di Gioia, Angela Di Maggio, Federica Di Marco, Christos Dimitriou, Sandra Dios-Barbeito, Andrea Divizia, Giuliano D'Onghia, Stefano D'Ugo, Audrius Dulskas, R Durai, Antonio D'Urso, Maurizio Eho, Sergey Efetov, Hossam Elfeki, Hazim Eltyeb, Tamer El Zalabany, Sameh Emile, Octavian Enciu, Alec Engledow, Mercedes Estaire-Gómez, M D Evans, Gustavo Factori, Francesco Falbo, Nicolò Falco, Ezio Falletto, Tommaso Farolfi, Alessia Fassari, Mohammad Fathy, Andrea Vincenzo Giuseppe Favara, Daniel M Felsenreich, Agostino Fernicola, Francesco Feroci, Francesco Ferrara, Lorenzo Ferri, Nikolaos Filippou, Sabrina Florea, Gaetano Florio, Fernando Font, Tommaso Fontana, Edoardo Forcignanó, Giampaolo Formisano, Laura Fortuna, Maria Roberta Fortunato, Pietro Fransvea, Alice Frontali, Serena Fulginiti, Giacomo Fuschillo, Linda Gabellini, Ioannis Galanis, Raffaele Galleano, José-María García-González, N García-Fernández, Tatiana Garmanova, Zoe Garoufalia, Carlo Gazia, Srinivasa Rao Geddam, Massimo Giacca, Valentina Giaccaglia, Marco Giacometti, Eleftherios Gialamas, Mauro Giambusso, Alessio Giordano, Mario Giuffrida, Giuseppe Giuliani, Dan-Eduard Giuvara, Juan Ramón Gómez López, Carolina C Gomez González, Carmen Loredana Gorgan, Lorenzo Gozzini, Florin Grama, Antonella Grasso, Sergio Grimaldi, Ugo Grossi, Tommaso Guagni, Claudio Guerci, Andrea Martina Guida, Meurette Guillaume, Baris Gulcu, Cem Emir Guldogan, SV Gurjar, Christian Helbling, Seung Ho Song, Nir Horesh, Giulio Iacob, Giuseppe Ietto, Aldo Infantino, Argyrios Ioannidis, Aristeidis Ioannidis, Orestis Ioannidis, Angelo Iossa, Tsvetomir Ivanov, John T Jenkins, Jovan Juloski, Viktor Kakotkin, Konstantina Katsiafliaka, Ekaterina Kazachenko, Dionysia Kelgiorgi, Deborah S Keller, Ishfaq Ahmad Khan, Sohaib Khan, Sanjay Khandagale, Georgia Kotoreni, Zoltan Kover, E.F.P Kuppens, Vasil Kyosev, Maria Labalde Martinez, Antonio Langone, Giovanni Guglielmo Laracca, Andrea Lauretta, Joël L. Lavanchy, Dusan Lesko, Georgios Lianos, Edoardo Liberatore, Annarita Libia, Eugenio Licardie, Edelweiss Licitra, Emilie Liot, Giorgio Lisi, Alexis Litchinko, Ana Isabel López Castillo, Pasquale Losurdo, Lydia Loutzidou, Federico Lovisetto, Aleksandr Lukianov, Andrea Pierre Luzzi, Enric Macarull, Isabella Madaffari, Federico Maggi, Stefano Magnone, Kashish Malhotra, Draga-Maria Mandi, Simone Manfredelli, Michele Manigrasso, Khaled Mansour, Luigi Marano, Ioannis Margaris, Federico Mariani, Franco Marinello, Davide Marino, Fabio Marino, Angelo Alessandro Marra, Javier Martínez Alegre, Fernando Martinez-Ubieto, Mauro Marzano, Davide Mascali, Manuela Mastronardi, Fernando Alcaide Matas, Michele Mazza, Federico Mazzotti, Francisco Javier Medina Fernández, Piercarlo Meinero, Liene Melberga, Danilo Meloni, Francesco Menegon Tasselli, Alessio Merendoni, David Merlini, Ilenia Merlini, Jeremy Meyer, Valentina Miacci, Andrea Minervini, Massimiliano Mistrangelo, Anuja T Mitra, Stelian Mogoanta, Mohammed M Mohammed, Helen Mohan, Serena Molica, Beatrice Molteni, Mattia Molteni, Isabella Mondi, Yunuen Morales-Tercero, Gianluigi Moretto, Andrea Morini, David Moro-Valdezate, Francesk Mulita, Mihai-Stefan Muresan, Valentina Murzi, Petronel Mustatea, Yoshihiko Nakamoto, Felice Nappi, Bruno Nardo, Peter Mark Neary, Carla Newton, Ashok Ninan Oommen, Ahmad Nizar Hachem Ibrahim, Georgios Ntampakis, Gianluca Occelli, Olatz Ocerin Alganza, Greta Olivari, Stefano Olmi, Ramadhani Omari Abdalla, Merve Önkaya, Francisco J Orts-Micó, Paolo Ossola, Massimo Ottonello, Radoslaw Pach, Mario Pacilli, Livia Palmieri, Giuseppe Palomba, Paolo Panaccio, Jose-Antonio Pando, Dalibor Panuska, Arpád Panyko, Giacomo Paolini, Vincenzo Papagni, Theodosios Papavramidis, Ganendra Paramasvaran, Nikolaos Pararas, G Pariza, Annalisa Pascariello, Francesco Pata, Giovanna Pavone, Giuseppe Pecorella, Gianluca Pellino, Andrea Peloso, Roberto Peltrini, Emilio Peña Ros, Anna Różańska-Walędziak, Filippo Pepe, Jose Alberto Pérez, Luis Eduardo Pérez-Sánchez, Konstantinos Perivoliotis, Thalia Petropoulou, Niccolo Petrucciani, Francesco Pezzolla, Biagio Picardi, Andrea Picchetto, Arcangelo Picciariello, Chiara Piceni, Renato Pietroletti, Nicoletta Sveva Pipitone Federico, Marco Platto, Mauro Podda, Andrei Popa, Vicente Portugal Porras, Gianmario Edoardo Poto, Mauro Pozzo, Silviu Daniel Preda, Francesco Puccetti, Ilaria Puccica, Filipe Ramalho de Almeida, Jorge Ramos Sanfiel, Gopi Ramu, Valentina Randazzo, Maria Chiara Ranucci, Arshad Rashid, Emeka Ray-Offor, Elisa Reitano, Marryam Riaz Farooqui, Raquel Rios Blanco, Frederic Ris, Giuseppe Rocco, Peter Rogers, Jose V. Roig, Francesco Romeo, Juan-Manuel Romero-Marcos, Ivan Romic, Fausto Rosa, Stefano Rossi, Matteo Rottoli, Maurizio Roveroni, María Rufas, Martin Rutegård, Luca Sacco, Ahmad Sakr, Silvia Salvans, Guray Sarp, Silvia Savastano, Odai Sawaqed, Valentin Scaunasu Razvan, Renske Schasfoort, Carlo Alberto Schena, Antonio Schimera, Dimitrios Schizas, Radu Razvan Scurtu, Simone Sebastiani, Radu Seicean, Miguel Semião, Ana Senent-Boza, Fatima Senra, Bruno Sensi, Alberto Serventi, Hüsnü Şevik, Mohammed Shawkat Hamad, Vishal G Shelat, Harsh Sheth, Mark Siboe, Laurențiu Simion, Baljit Singh, Sandeep Singh, Gurpreet Singh-Ranger, Leandro Siragusa, Alistair AP Slesser, Elia Smerieri, Gabriele Soldini, Dmitry Solovyev, Amine Souadka, Maria Sotiropoulou, Iván Soto-Darias, Marta Spalluto, Victor Stefanescu, Jasper Stijns, Natalia Suarez, Luca Sullo, Athanasios Syllaios, Luis Tallon-Aguilar, Andrea Marco Tamburini, Cinzia Tanda, Manish Tardeja, Nicola Tartaglia, Giovanni Tebala, Patricia Tejedor, Gaetano Tessera, Teoh Tiong-Ann, George Theodoropoulos, Luca Tirloni, Iris Isamar Tiscareño Lozano, Elena-Adelina Toma, Giovanni Tomasicchio, Paolo Tonello, Beatrice Torre, Francesca Paola Tropeano, Jeancarlos Trujillo-Díaz, Yegor Tryliskyy, Irene Tucceri Cimini, Giulia Turri, Amir Tursunovic, Roberta Tutino, Georgios Tziko, Arda Ulaş Mutlu, Alessandro Ussia, Maria Rosaria Valenti, Michail Vailas, Stefan E. van Oostendorp, Fernando Vazquez, Antonella Veglia, Paolina Venturelli, Daunia Verdi, Georgios Ioannis Verras, Francesca Vescio, Elena Viejo Martínez, Vincenzo Vigorita, Guy Vijgen, Viola Villardita, Danilo Vinci, Ioannis Virlos, Angeliki Vouchara, Maciej Walędziak, Hamza Waqar Bhatti, Malcolm A West, Sofia Xenaki, Omer Yalkin, Tunc Yalti, Muhammad Umar Younis, Mustafa Yener Uzunoglu, Tarek M Zaghloul, Konstantinos Zapsalis, Krawczuk Zbigniew, Serkan Zenger, Daniele Zigiotto, Roberto Zinicola, Paul Ziprin, Maurizio Zizzo

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Authors and Affiliations

  1. Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Andrea Balla

  2. UOC of General and Minimally Invasive Surgery, Hospital “San Paolo”, Largo Donatori del Sangue 1, 00053, Rome, Civitavecchia, Italy

    Federica Saraceno

  3. Department of General Surgery, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura, Egypt

    Mostafa Shalaby

  4. Department of Surgery, Sapienza University of Rome, Rome, Italy

    Gaetano Gallo

  5. ASUR Marche 5, San Benedetto del Tronto General Hospital, San Benedetto del Tronto, Italy

    Salomone Di Saverio

  6. Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy

    Paola De Nardi

  7. General Surgery, SS Colo-Rectal and Proctological Surgery, Biella Hospital, Ponderano, Biella, Italy

    Roberto Perinotti

  8. Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy

    Pierpaolo Sileri

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  1. Andrea Balla
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Consortia

Anal Fissure Collaborative Group

  • Bourguiba Mohamed Aboulkacem
  • , Tewodros Abule
  • , Mikhail Agapov
  • , Ferdinando Agresta
  • , Alberto Aiolfi
  • , Abdulahad Al-Ameri
  • , Mehmet Ali Koç
  • , Vusal Aliyev
  • , Abdullah Alkhuzaie
  • , Michele Ammendola
  • , Giorgio Ammerata
  • , Marco Anania
  • , Jacopo Andreuccetti
  • , Elissavet Anestiadou
  • , Genna Aníbal
  • , Alfredo Annicchiarico
  • , Pietro Anoldo
  • , Amedeo Antonelli
  • , Giovanni Aprea
  • , Francesco Arcanà
  • , Massimiliano Ardu
  • , Alberto Arezzo
  • , Giulio Argenio
  • , Gabriela Arroyo Murillo
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  • , Javier Martínez Alegre
  • , Fernando Martinez-Ubieto
  • , Mauro Marzano
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  • , Manuela Mastronardi
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  • , Michele Mazza
  • , Federico Mazzotti
  • , Francisco Javier Medina Fernández
  • , Piercarlo Meinero
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  • , Ilenia Merlini
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  • , Gianluca Occelli
  • , Olatz Ocerin Alganza
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  • , Merve Önkaya
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  • , Ganendra Paramasvaran
  • , Nikolaos Pararas
  • , G Pariza
  • , Annalisa Pascariello
  • , Francesco Pata
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  • , Anna Różańska-Walędziak
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  • , Andrei Popa
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  • , Gianmario Edoardo Poto
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  • , Silviu Daniel Preda
  • , Francesco Puccetti
  • , Ilaria Puccica
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  • , Valentina Randazzo
  • , Maria Chiara Ranucci
  • , Arshad Rashid
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  • , Elisa Reitano
  • , Marryam Riaz Farooqui
  • , Raquel Rios Blanco
  • , Frederic Ris
  • , Giuseppe Rocco
  • , Peter Rogers
  • , Jose V Roig
  • , Francesco Romeo
  • , Juan-Manuel Romero-Marcos
  • , Ivan Romic
  • , Fausto Rosa
  • , Stefano Rossi
  • , Matteo Rottoli
  • , Maurizio Roveroni
  • , María Rufas
  • , Martin Rutegård
  • , Luca Sacco
  • , Ahmad Sakr
  • , Silvia Salvans
  • , Guray Sarp
  • , Silvia Savastano
  • , Odai Sawaqed
  • , Valentin Scaunasu Razvan
  • , Renske Schasfoort
  • , Carlo Alberto Schena
  • , Antonio Schimera
  • , Dimitrios Schizas
  • , Radu Razvan Scurtu
  • , Simone Sebastiani
  • , Radu Seicean
  • , Miguel Semião
  • , Ana Senent-Boza
  • , Fatima Senra
  • , Bruno Sensi
  • , Alberto Serventi
  • , Hüsnü Şevik
  • , Mohammed Shawkat Hamad
  • , Vishal G Shelat
  • , Harsh Sheth
  • , Mark Siboe
  • , Laurențiu Simion
  • , Baljit Singh
  • , Sandeep Singh
  • , Gurpreet Singh-Ranger
  • , Leandro Siragusa
  • , Alistair AP Slesser
  • , Elia Smerieri
  • , Gabriele Soldini
  • , Dmitry Solovyev
  • , Amine Souadka
  • , Maria Sotiropoulou
  • , Iván Soto-Darias
  • , Marta Spalluto
  • , Victor Stefanescu
  • , Jasper Stijns
  • , Natalia Suarez
  • , Luca Sullo
  • , Athanasios Syllaios
  • , Luis Tallon-Aguilar
  • , Andrea Marco Tamburini
  • , Cinzia Tanda
  • , Manish Tardeja
  • , Nicola Tartaglia
  • , Giovanni Tebala
  • , Patricia Tejedor
  • , Gaetano Tessera
  • , Teoh Tiong-Ann
  • , George Theodoropoulos
  • , Luca Tirloni
  • , Iris Isamar Tiscareño Lozano
  • , Elena-Adelina Toma
  • , Giovanni Tomasicchio
  • , Paolo Tonello
  • , Beatrice Torre
  • , Francesca Paola Tropeano
  • , Jeancarlos Trujillo-Díaz
  • , Yegor Tryliskyy
  • , Irene Tucceri Cimini
  • , Giulia Turri
  • , Amir Tursunovic
  • , Roberta Tutino
  • , Georgios Tziko
  • , Arda Ulaş Mutlu
  • , Alessandro Ussia
  • , Maria Rosaria Valenti
  • , Michail Vailas
  • , Stefan E. van Oostendorp
  • , Fernando Vazquez
  • , Antonella Veglia
  • , Paolina Venturelli
  • , Daunia Verdi
  • , Georgios Ioannis Verras
  • , Francesca Vescio
  • , Elena Viejo Martínez
  • , Vincenzo Vigorita
  • , Guy Vijgen
  • , Viola Villardita
  • , Danilo Vinci
  • , Ioannis Virlos
  • , Angeliki Vouchara
  • , Maciej Walędziak
  • , Hamza Waqar Bhatti
  • , Malcolm A West
  • , Sofia Xenaki
  • , Omer Yalkin
  • , Tunc Yalti
  • , Muhammad Umar Younis
  • , Mustafa Yener Uzunoglu
  • , Tarek M Zaghloul
  • , Konstantinos Zapsalis
  • , Krawczuk Zbigniew
  • , Serkan Zenger
  • , Daniele Zigiotto
  • , Roberto Zinicola
  • , Paul Ziprin
  •  & Maurizio Zizzo

Contributions

AB: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. Final approval. FS: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. Final approval. MS: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. Final approval. GG: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. Final approval. SDS: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. Final approval. PDN: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. Final approval. RP: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. Final approval. PS: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. Final approval.

Corresponding author

Correspondence to Andrea Balla.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Balla, A., Saraceno, F., Shalaby, M. et al. Surgeons’ practice and preferences for the anal fissure treatment: results from an international survey. Updates Surg 75, 2279–2290 (2023). https://doi.org/10.1007/s13304-023-01661-x

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