The Practices and Preferences of Turkish Surgeons in the Treatment of Anal Fissure

Abstract Despite different medical and surgical options for the treatment of anal fissure no international consensus has been reached. The aim of this study was to determine current practices and preferences of Turkish surgeons when treating anal fissure. Two groups were formed according to numbers of anal fissure patients treated per year (0-50 or >50 patients) and were then compared in respect of responses to questions about diagnosis, treatment and clinical approaches to anal fissure. A total of 300 Turkish surgeons completed the questionnaire: 50.7% in Group 1 (0-50 patients per year) and 49.3% in Group 2 (>50 patients per year). The leading diagnostic method was reported to be physical examination (84.0%). The first approach in treatment was support treatment + topical medical treatment together (82.0%), and when this does not provide recovery, the next option is lateral internal sphincterotomy (LIS) (54.5%). Botulinium toxin injection (BTI) was preferred more by the Group 2 respondents (13.8% vs.23.0%). The use of phlebotonic drugs was lower in Group 2 (45.4% vs.33.1%, p = 0.029). Fetal incontinence is considered in the decision for LIS (82.8%). Limited application of BTI was reported (38.7%) and 17.0% stated that in healthcare facilities in Türkiye there was no institutional treatment protocol for anal fissure. Main lines of anal fissure treatment in daily practice in Türkiye are in parallel with current international practice. For the updating and standardization of anal fissure treatment, national meetings and studies must be increased and a national anal fissure treatment algorithm should be prepared.