More and more authors believe, that the cause of the chronic anal fissure is the increased anal resting pressure. It maintains a vicious circle causing ischaemia and ulcer on the anoderm. There are many traditional surgical methods treating fissures apart from the conservative ways. However, these are likely to cause significant morbidity. Chemical sphincterotomy seems to be a novel way and its most effective drugs are the nitrates. 75-80% of the patients can be cured with the topical use of these. This treatment has to be accompanied with the normalisation of the stools. If the symptoms persist after 6-8 weeks the procedure of choice is the lateral sphincterotomy. Authors evaluate the different treatments based on a literature overview and own experiences. They also suggest a treatment protocol.
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