Chronic Anal Fissure in Male Patients After Lateral Internal Sphincterotomy Failure

This protocol applies to male patients with a chronic anal fissure that has persisted despite initial surgical or injection-based intervention following conservative management — where the primary therapeutic goal of fissure healing was not achieved.

Clinical Scenario

The patient is male with a chronic anal fissure that has not resolved after sequential conservative management with laxatives and topical therapy, then first-line surgical or pharmacological treatment directed at the internal anal sphincter.

Previous Treatment — Failure Condition

The prior line included lateral internal sphincterotomy (taken to the dentate line), or for patients who declined sphincter division or had pre-existing continence concerns, botulinum toxin injection. The defined goal of that intervention — healing of the fissure — was not achieved, triggering escalation to this protocol.

Next-Step Approach (partial)

When the fissure persists after the initial procedure, further management is guided by a structured sphincter assessment — but the specific intervention that follows, and whether a more conservative or more aggressive path is taken, depends entirely on the findings of that assessment.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/codi.167

For male patients with chronic fissure persisting after laxatives and topical therapy, a lateral internal sphincterotomy should be considered.

In patients in whom lateral sphincterotomy has failed to heal the fissure, sphincter assessment using endoanal ultrasound and sphincter pressure measurement may be considered to help plan further intervention.

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