Management of Anal Fissure

บทคัดย่อ

Anal fissure is a surgical disease commonly found at outpatients department. The symptoms patients complaint bleeding per rectum, anal pain, skin tag at anal verge, pruritus ani. The history of patients and by physical examination. Anal fissures are classified into acute and chronic according to the duration of symptoms and wound appearance. Most of pantients diagnosed with acute anal fissure can be healed by supportive treatment, whereas the gold standard treatment for chronic fissures is lateral internal sphincterotomy (LIS). The operation yields high healing rate, but several surgical complications such as fecal incontinence and wound infection in some patients. Nowadays our understanding of fissure pathophysiology has developed, more medical treatments have been used. They have higher healing rate, less fecal incontinence complication. Many guidelines suggest medical treatments are fist line management in chronic anal fissure, consider surgical treatment if fissure is not healing.