Innovations in chronic anal fissure treatment: A systematic review

Table 2 Studies comparing complication rates of different pharmacological therapies

S/N	Ref.	Study details	Results
1	Lund et al[17] 1997 Double armed, prospective, randomized	0.2% GTN vs placebo 80 patients	Headaches-56.4% (GTN) vs 17.9% (placebo)
2	Altomare et al[19] 2000 Double arm, prospective, randomized	0.2% GTN vs placebo 132 patients	Headaches-33.8% (GTN) vs 7.8% (placebo)
3	Scholefield et al[20] 2003 Four armed, prospective, randomized	0.1% GTN vs 0.2% GTN vs 0.4% GTN vs placebo 200 patients	Headaches-31% (treatment group) vs 12.5% (placebo group) Severe headaches-19.6% (0.4% GTN) vs 5.9% (0.2% GTN) vs 2% (0.1% GTN) vs 4.2% (placebo)
4	Knight et al[27] 2001 Single arm, prospective, non-randomized	2% Diltiazem cream for chronic anal fissures 71 patients	Complications: 1 (headache) and 1 (allergic dermatitis)
5	Jonas et al[26] 2002 Single arm, prospective, non-randomized	Topical 2% diltiazem for fissures failing GTN therapy 39 patients	Perineal itchiness-10% (no drop-out from treatment)
6	Maria et al[21] 1998 Double arm, prospective, randomized	Botulinum toxin 20 units vs saline 30 patients	No significant complications noted in the botulinum toxin group
7	Lindsey et al[24] 2003 Single arm, prospective, non-randomized	Botulinum toxin 20 units injection for non-healing anal fissures after initial 8 wk of 0.2% GTN 40 patients	18% minor incontinence-resolved
8	Brisinda et al[22] 1999 Dual arm, prospective randomized, non-randomized	Botulinum toxin 20 units injection vs 0.2% GTN for 8 wk Failure to heal after 8 wk-treatment offered from the other arm 50 patients	Headaches – 20% in GTN arm No bleeding complications in Botulinum arm
9	Jones et al[28] 2006 Dual arm, prospective randomized, non-randomized	Botulinum toxin 25 units injection and 0.2% GTN vs Botulinum toxin 25 units alone 30 patients	Botulinum toxin and GTN-33% transient incontinence rate Botulinum toxin alone-13% transient incontinence rate
10	Garrido et al[8] 2007 Single arm, prospective, non-randomized	Gonyautoxin 100 units injection 23 patients	No flatus or fecal incontinence

GTN: Glyceryl trinitrate.