Anal Fissure Research Across Four Decades: Global Trends and Emerging Directions

BACKGROUND/AIMS: Anal fissure is a common and painful anorectal disorder that substantially impairs quality of life. While therapeutic strategies have evolved from pharmacological sphincter relaxation and botulinum toxin injections to sphincter-preserving surgical and regenerative approaches, the global research landscape has not previously been assessed through bibliometric methods. MATERIALS AND METHODS: A bibliometric analysis was conducted using the Web of Science Core Collection, covering the period 1980-2025. Publications were retrieved with the keywords “anal fissure*,” “fissure-in-ano,” “fissura ani,” and “anorectal fissure*”. Only articles and reviews were included. Network visualization was performed with VOSviewer, geographical mapping with Tableau, and statistical analyses with SPSS. Linear regression was applied to predict future publication trends. RESULTS: A total of 1,504 records were identified, of which 1,241 were included (articles and reviews). The corpus accrued 23,277 citations across 8,572 publications, with an h-index of 71. Annual publications increased steadily, with a projected 78 papers in 2040 (R²=0.864, p<0.001). The United States, Italy, and the United Kingdom were the most productive countries, while Türkiye, India, Pakistan, and Egypt demonstrated emerging but peripheral contributions. Collaboration mapping revealed five international clusters, with the United States acting as a global hub. The New England Journal of Medicine and Diseases of the Colon & Rectum were among the most cited journals. Keyword analysis showed a thematic transition from pharmacological therapies (glyceryl trinitrate, diltiazem, nifedipine) to botulinum toxin and sphincter-preserving surgery, with a recent emphasis on wound healing, recurrence, quality of life, and systematic reviews. CONCLUSION: This first bibliometric analysis of anal fissure research highlights a sustained increase in global output and a shift toward patient-centered outcomes and minimally invasive strategies. While high-income countries dominate, emerging economies are contributing more actively. Future research should prioritize multicenter randomized trials, long-term quality-of-life and cost-effectiveness studies, and mechanistic investigations of ischemia, microbiota, and systemic factors in fissure chronicity.