Management Strategies for Chronic Anal Fissures and Anal Fistulas: Efficacy and Safety

Chronic anal fissures (CAFs) are a prevalent anorectal disorder recognized for causing significant morbidity and reducing the quality of life of those affected. Initially described by Lockhart-Mummery, anal fissures are defined as linear or oval-shaped tears in the anoderm. The treatment landscape for CAF has evolved over the years, with options categorized into surgical and non-surgical methods. While lateral internal sphincterotomy remains the surgical gold standard, various techniques have been developed to minimize complications such as fecal incontinence. Concurrently, the past two decades have witnessed an increasing preference for less invasive, conservative treatment options, including glyceryl trinitrate ointment, local anesthetics such as lidocaine, steroids, calcium channel-blocking drugs, diltiazem ointments, and botulinum toxin injections. Despite the array of available therapies, there remains ongoing debate in the literature regarding their efficacy and safety profiles.

Anal fistulas represent another common and impactful benign anorectal condition, typically arising from cryptoglandular infection and often associated with recurrent abscesses, chronic drainage, pain, and impaired quality of life. Their management can be complex and must balance durable healing with preservation of continence. Contemporary approaches range from fistulotomy and seton strategies to sphincter-sparing and minimally invasive techniques (e.g., advancement flap, LIFT, plugs, fibrin glue, laser and endoscopic methods), as well as tailored pathways for complex and recurrent disease.

This Research Topic aims to systematically compare different management strategies for chronic anal fissures and anal fistulas to determine their efficacy, safety, and impact on patient quality of life. By critically evaluating both surgical and non-surgical interventions—and the clinical contexts in which they are used—this Topic seeks to clarify which approaches offer the best balance of effectiveness and functional outcomes, and under what conditions certain strategies outperform others. We also welcome work addressing shared challenges across these conditions, including patient selection, peri-operative care, continence preservation, recurrence prevention, and patient-reported outcomes.

To gather further insights into the comparison of these management strategies, we welcome articles addressing, but not limited to, the following themes:
o Comparative analysis of surgical and non-surgical treatments for CAF and anal fistulas;
o Long-term outcomes and quality of life after fissure and fistula treatment;
o Advances in minimally invasive and sphincter-sparing procedures for fissures and fistulas;
o Efficacy and safety profiles of novel medical therapies for CAF and novel procedural approaches for fistulas;
o Patient-centered approaches, shared decision-making, and decision drivers (e.g., continence risk, complexity, recurrence risk);
o Imaging and classification to guide management (e.g., endoanal ultrasound/MRI; fistula complexity; chronic fissure features);
o Management of recurrent or complex disease, including treatment sequencing and combination strategies;
o Special populations and etiologies where relevant (e.g., Crohn’s-related fistulas vs cryptoglandular; postpartum; immunosuppression) and how these influence outcomes.

We accept submissions in the form of original research articles, reviews, and case studies.

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• ... View all formats

Articles that are accepted for publication by our external editors following rigorous peer review incur a publishing fee charged to Authors, institutions, or funders.

Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Review
• Study Protocol
• Systematic Review
• Technology and Code

Keywords: Chronic Anal Fissures, Non-Surgical Techniques, Surgical Techniques, Anorectal Disorders, CAFs, Long-Term Outcomes, Minimally Invasive Procedures, Anal Fissures

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.