Personalized treatment algorithm for acute anal fissures: comparison with traditional symptomatic therapy

Abstract

OBJECTIVE – to evaluate the clinical efficacy of a personalized treatment algorithm for acute anal fissures based on a fissure chronicity risk scale compared with standard symptomatic therapy. MATERIALS AND METHODS. This prospective non-randomized comparative study included 175 patients with acute anal fissure treated at the proctology department of Kyiv City Clinical Hospital № 18 between 2021 and 2024. The mean patient age was 39.29 ± 12.98 years. The study group received individualized treatment based on chronicity risk assessment, while the control group received standard symptomatic treatment. Efficacy was assessed by the rate of complete healing at week 4, pain dynamics on the VAS scale, and the incidence of chronicity. RESULTS. The personalized treatment protocol resulted in a higher rate of complete healing compared to standard therapy (81.63 % versus 41.56 %, p < 0.001). The incidence of chronicity of anal fissures was lower in the study group (4.08 %) than in the control group (23.38 %). Patients in the study group achieved pain reduction of more than 50 % faster than those in the control group (6.1 ± 2.3 versus 12.8 ± 3.5 days). Side effects were observed in both groups, including local redness (11 % and 14 %), temporary incontinence (7 % and 0 %), and headache (0 % and 3 %). CONCLUSIONS. The personalized protocol for managing acute anal fissures shows higher efficacy and significantly improved clinical outcomes compared to standard conservative therapy. Implementation of this approach in clinical practice accelerates healing, reduces chronicity rates, and lowers early recurrence. Therefore, adoption of the proposed protocol is recommended.