{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:30:28Z","timestamp":1780619428493,"version":"3.54.1"},"reference-count":53,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T00:00:00Z","timestamp":1632441600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T00:00:00Z","timestamp":1632441600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Lateral internal sphincterotomy (LIS) is still the approach of choice for the treatment of chronic anal fissure (CAF) regardless to the internal anal sphincter tone but it is burdened by high risk post-operative faecal incontinence (FI). In female patient there are some anatomical and functional differences of the sphinteric system which make them more at risk of FI and vaginal birth could cause sphinteric lesions affecting the anal continence function. The aim of our study is to evaluate the results of saving sphincter procedure as treatment for female patients affected by CAF.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We studied 110 female patients affected by CAF undergone fissurectomy and anoplasty with V\u2013Y cutaneous flap advancement associating pharmacological sphincterotomy in patients with hypertonic IAS. The follow up was at least for 2\u00a0years. The goals were patient\u2019s complete healing, the evaluation of FI, recurrence rate and manometry parameters.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>All wounds healed within 40\u00a0days after surgery. We recorded 8 cases of recurrences 6 healed with medical therapy and 2 with dilatation. We recorded 2 \u201cde novo\u201d temporary and low grade post-operative cases of FI. Post-operative value of MRP were unmodified in patient with normotonic IAS but significantly lower at 12\u00a0months follow up as compared with the pre-operative ones in patients with hypertonic IAS; after 24\u00a0months from surgery MRP values were within the normal range.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The fissurectomy and anoplasty with V\u2013Y cutaneous flap alone or in association with a pharmacological sphincterotomy in patients with hypertonic IAS may represent an effective approach for the treatment of CAF in female patients.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12893-021-01346-5","type":"journal-article","created":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T09:46:09Z","timestamp":1632476769000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Safety and effectiveness of saving sphincter procedure in the treatment of chronic anal fissure in female patients"],"prefix":"10.1186","volume":"21","author":[{"given":"Beatrice","family":"D\u2019Orazio","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girolamo","family":"Geraci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastiano","family":"Bonventre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Cal\u00ec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2835-3273","authenticated-orcid":false,"given":"Gaetano","family":"Di Vita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,24]]},"reference":[{"key":"1346_CR1","doi-asserted-by":"publisher","first-page":"e104","DOI":"10.1111\/codi.12108","volume":"15","author":"P Garg","year":"2013","unstructured":"Garg P, Garg M, Menon GR. Long-term continence disturbance after lateral internal sphincterotomy for chronic anal fissure: a systematic review and meta-analysis. Colorectal Dis. 2013;15:e104\u201317.","journal-title":"Colorectal Dis"},{"key":"1346_CR2","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1111\/j.1463-1318.2004.00576.x","volume":"6","author":"N Griffin","year":"2004","unstructured":"Griffin N, Acheson AG, Tung P, Sheard C, Glazebrook C, Scholefield JH. Quality of life in patients with chronic anal fissure. Colorectal Dis. 2004;6:39\u201344.","journal-title":"Colorectal Dis"},{"key":"1346_CR3","doi-asserted-by":"publisher","DOI":"10.1590\/0100-6991e-20192181","volume":"46","author":"CW Sobrado J\u00fanior","year":"2019","unstructured":"Sobrado J\u00fanior CW, Hora JAB, Sobrado LF, Guzela VR, Nahas SC, Cecconello I. Anoplasty with skin tag flap for the treatment of chronic anal fissure. Rev Col Bras Cir. 2019;46: e20192181.","journal-title":"Rev Col Bras Cir"},{"key":"1346_CR4","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1007\/s00053-020-00448-7","volume":"42","author":"L Marti","year":"2020","unstructured":"Marti L, Post S, Herold A, Scwandner O, Hetzer F, Strittmatter B, Iesalnieks I, Huth M, Schmit-Lauber M, Weyandt G, Ommer A, Ebinger SM. S3-Leitlinie: Analfissur. AWMF-Registriernummer:081-010. Coloproctology. 2020;42:90\u20136.","journal-title":"Coloproctology"},{"key":"1346_CR5","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1007\/s10151-011-0683-7","volume":"15","author":"DF Altomare","year":"2011","unstructured":"Altomare DF, Binda GA, Canuti S, Landolfi V, Trompetto M, Villani R. The management of patients with primary chronic anal fissure: a position paper. Tech Coloproctol. 2011;15:135\u201341.","journal-title":"Tech Coloproctol"},{"key":"1346_CR6","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1016\/S0210-5705(08)75815-1","volume":"31","author":"P Alonso-Coello","year":"2008","unstructured":"Alonso-Coello P, Marzo-Castillejo M, Mascort JJ, Herv\u00e1s AJ, Vi\u00f1a LM, Ferr\u00fas JA, Ferr\u00e1ndiz J, L\u00f3pez-Rivas L, Rigau D, Sol\u00e0 I, Bonfill X, Piqu\u00e9 JM. Clinical practice guideline on the treatment of hemorrhoids and anal fissure (update 2007). Gastroenterol Hepatol. 2008;31:668\u201381.","journal-title":"Gastroenterol Hepatol"},{"key":"1346_CR7","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1007\/s00053-020-00454-9","volume":"42","author":"M Holzgang","year":"2020","unstructured":"Holzgang M, Jayne D. Lateral internal sphincterotomy (LIS)\u2014still top gun in chronic anal fissure treatment? Coloproctology. 2020;42:478\u201384.","journal-title":"Coloproctology"},{"key":"1346_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/j.1463-1318.2008.01681.x","volume":"3","author":"KL Cross","year":"2008","unstructured":"Cross KL, Massey EJ, Fowler AL, Monson JR, ACPGBI. The\u00a0management\u00a0of\u00a0anal fissure: ACPGBI position statement. Colorectal Dis. 2008;3:1\u20137.","journal-title":"Colorectal Dis"},{"key":"1346_CR9","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1097\/DCR.0000000000000724","volume":"60","author":"SH Emile","year":"2017","unstructured":"Emile SH. Indications and technical aspects of internal anal sphincterotomy: highlighting the controversies. Dis Colon Rectum. 2017;60:128\u201332.","journal-title":"Dis Colon Rectum"},{"key":"1346_CR10","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1148\/radiology.217.2.r00nv13395","volume":"217","author":"E Rociu","year":"2000","unstructured":"Rociu E, Stoker J, Eijkemans MJ, Lam\u00e9ris JS. Normal anal sphincter anatomy and age- and sex-related variations at high-spatial-resolution endoanal MR imaging. Radiology. 2000;217:395\u2013401.","journal-title":"Radiology"},{"key":"1346_CR11","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1177\/000313481207800531","volume":"78","author":"R Patti","year":"2012","unstructured":"Patti R, Territo V, Aiello P, Angelo GL, Di Vita G. Manometric evaluation of internal anal sphincter after fissurectomy and anoplasty for chronic anal fissure: a prospective study. Am Surg. 2012;78:523\u20137.","journal-title":"Am Surg"},{"key":"1346_CR12","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1007\/s10350-004-0753-2","volume":"48","author":"OM Jones","year":"2005","unstructured":"Jones OM, Ramalingam T, Lindsey I, Cunningham C, George BD, Mortensen NJ. Digital rectal examination of sphincter pressures in chronic anal fissure is unreliable. Dis Colon Rectum. 2005;48:349\u201352.","journal-title":"Dis Colon Rectum"},{"key":"1346_CR13","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s13304-012-0147-2","volume":"64","author":"R Patti","year":"2012","unstructured":"Patti R, Guercio G, Territo V, Aiello P, Angelo GL, Di Vita G. Advancement flap in the management of chronic anal fissure: a prospective study. Updates Surg. 2012;64:101\u20136.","journal-title":"Updates Surg"},{"key":"1346_CR14","doi-asserted-by":"publisher","DOI":"10.1007\/s13304-020-00846-y","author":"B D\u2019Orazio","year":"2020","unstructured":"D\u2019Orazio B, Geraci G, Martorana G, Scium\u00e9 C, Corbo G, Di Vita G. Fisurectomy and anoplasty with botulinum toxin injection in patients with chronic anal posterior fissure with hypertonia: a long-term evaluation. Updates Surg. 2020. https:\/\/doi.org\/10.1007\/s13304-020-00846-y.","journal-title":"Updates Surg."},{"key":"1346_CR15","doi-asserted-by":"publisher","first-page":"585","DOI":"10.21614\/chirurgia.115.5.585","volume":"115","author":"B D\u2019Orazio","year":"2020","unstructured":"D\u2019Orazio B, Scium\u00e9 C, Fam\u00e0 F, Bonventre S, Martorana G, Cal\u00ec D, Terranova G, Di Vita G, Geraci G. Surgical sphincter saving approach and topical nifedipine for chronic anal fissure with hypertonic internal anal sphincter. Chirurgia. 2020;115:585\u201394.","journal-title":"Chirurgia"},{"key":"1346_CR16","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1007\/BF02049407","volume":"35","author":"M Pescatori","year":"1992","unstructured":"Pescatori M, Anastasio G, Bottini C, Mentasti A. New grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum. 1992;35:482\u20137.","journal-title":"Dis Colon Rectum"},{"key":"1346_CR17","doi-asserted-by":"publisher","first-page":"2052","DOI":"10.1007\/s00268-007-9177-1","volume":"31","author":"MM Elsebae","year":"2007","unstructured":"Elsebae MM. A study of fecal incontinence in patients with chronic anal fissure: prospective, randomized, controlled trial of the extent of internal anal sphincter division during lateral sphincterotomy. World J Surg. 2007;31:2052\u20137.","journal-title":"World J Surg"},{"issue":"4","key":"1346_CR18","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1007\/BF02054061","volume":"39","author":"J Garcia-Aguilar","year":"1996","unstructured":"Garcia-Aguilar J, Belmonte C, Wong WD, Lowry AC, Madoff RD. Open vs closed sphincterotomy for chronic anal fissure: long-term results. Dis Colon Rectum. 1996;39(4):440\u20133.","journal-title":"Dis Colon Rectum"},{"key":"1346_CR19","doi-asserted-by":"publisher","first-page":"1461","DOI":"10.1007\/s00384-018-3087-6","volume":"33","author":"M Alawady","year":"2018","unstructured":"Alawady M, Emile SH, Abdelnaby M, Elbanna H, Farid M. Posterolateral versus lateral internal anal sphincterotomy in the treatment of chronic anal fissure: a randomized controlled trial. Int J Colorectal Dis. 2018;33:1461\u20137.","journal-title":"Int J Colorectal Dis"},{"key":"1346_CR20","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1002\/bjs.4882","volume":"92","author":"KS Ho","year":"2005","unstructured":"Ho KS, Ho YH. Randomized clinical trial comparing oral nifedipine with lateral anal sphincterotomy and tailored sphincterotomy in the treatment of chronic anal fissure. Br J Surg. 2005;92:403\u20138.","journal-title":"Br J Surg"},{"key":"1346_CR21","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1007\/s10350-007-9121-3","volume":"51","author":"BB Mente\u015f","year":"2008","unstructured":"Mente\u015f BB, G\u00fcner MK, Leventoglu S, Aky\u00fcrek N. Fine-tuning of the extent of lateral internal sphincterotomy: spasm-controlled vs up to the fissure apex. Dis Colon Rectum. 2008;51:128\u201333.","journal-title":"Dis Colon Rectum"},{"key":"1346_CR22","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1007\/s10350-006-0844-3","volume":"50","author":"CJ Brown","year":"2007","unstructured":"Brown CJ, Dubreuil D, Santoro L, Liu M, O\u2019Connor BI, McLeod RS. Lateral internal sphincterotomy is superior to topical nitroglycerin for healing chronic anal fissure and does not compromise long-term fecal continence: six-year follow-up of a multicenter, randomized, controlled trial. Dis Colon Rectum. 2007;50:442\u20138.","journal-title":"Dis Colon Rectum"},{"key":"1346_CR23","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1007\/s12262-016-1467-0","volume":"79","author":"G Nessar","year":"2017","unstructured":"Nessar G, Topbas M. Lateral internal partial sphincterotomy technique for chronic anal fissure. Indian J Surg. 2017;79:185\u20137.","journal-title":"Indian J Surg"},{"key":"1346_CR24","unstructured":"D\u2019Orazio B, Bonventre S, Scium\u00e9 C, Cudia B, Terranova G, Di Vita G, Geraci G. Lateral Internal Sphincterotomy is still crucial to heal hypertonic chronic anal fissure and normalize the internal anal sphincter tone? Is\u00a0fissurectomy\u00a0and V en Y plastic a valuable alternative? Ann Ital Chir. 2021; 92. Accepted for publication"},{"key":"1346_CR25","doi-asserted-by":"publisher","first-page":"2207","DOI":"10.1007\/s00464-007-9339-0","volume":"21","author":"FS Regadas","year":"2007","unstructured":"Regadas FS, Murad-Regadas SM, Lima DM, Silva FR, Barreto RG, Souza MH, Regadas Filho FS. Anal canal anatomy showed by three-dimensional anorectal ultrasonography. Surg Endosc. 2007;21:2207\u201311.","journal-title":"Surg Endosc"},{"key":"1346_CR26","unstructured":"D\u2019Orazio B, Geraci G, Fam\u00e0 F, Cudia B, Martorana G, Scium\u00e9 C, Corbo G, Terannova G, Bonventre S, Di Vita G. Long term outcomes of fissurectomy and anoplasty for chronic anterior anal fissure without hypertonia: low recurrences and continence conservation. Ann Ital Chir. 2020; 9. pii: S0003469X20034727. Online ahead of print."},{"key":"1346_CR27","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1007\/s10350-004-0549-4","volume":"47","author":"CN Ellis","year":"2004","unstructured":"Ellis CN. Anterior levatorplasty for the treatment of chronic anal fissures in females with a rectocele: a randomized, controlled trial. Dis Colon Rectum. 2004;47:1170\u20133.","journal-title":"Dis Colon Rectum"},{"key":"1346_CR28","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1056\/NEJM199312233292601","volume":"329","author":"AH Sultan","year":"1993","unstructured":"Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. N Engl J Med. 1993;329:1905\u201311.","journal-title":"N Engl J Med"},{"key":"1346_CR29","doi-asserted-by":"publisher","first-page":"1394","DOI":"10.1097\/01.AOG.0000246799.53458.bc","volume":"108","author":"HE Richter","year":"2006","unstructured":"Richter HE, Fielding JR, Bradley CS, Handa VL, Fine P, FitzGerald MP, Visco A, Wald A, Hakim C, Wei JT, Weber AM. Pelvic floor disorders network endoanal ultrasound findings and fecal incontinence symptoms in women with and without recognized anal sphincter tears. Obstet Gynecol. 2006;108:1394\u2013401.","journal-title":"Obstet Gynecol"},{"key":"1346_CR30","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1111\/j.1463-1318.2009.01867.x","volume":"12","author":"P Garg","year":"2010","unstructured":"Garg P. Water stream in a bidet-toilet as a cause of anterior fissure-in-ano: a preliminary report. Colorectal Dis. 2010;12:601\u20132.","journal-title":"Colorectal Dis"},{"key":"1346_CR31","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1111\/j.1463-1318.2009.02068.x","volume":"12","author":"R Patti","year":"2010","unstructured":"Patti R, Fam\u00e0 F, Barrera T, Migliore G, Di Vita G. Fissurectomy and anal advancement flap for anterior chronic anal fissure without hypertonia of the internal anal sphincter in females. Colorectal Dis. 2010;12:1127\u201330.","journal-title":"Colorectal Dis"},{"key":"1346_CR32","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.1007\/s00384-014-1961-4","volume":"29","author":"HR Lee","year":"2014","unstructured":"Lee HR, Lim SB, Park JY. Anorectal manometric parameters are influenced by gender and age in subjects with normal bowel function. Int J Colorectal Dis. 2014;29:1393\u20139.","journal-title":"Int J Colorectal Dis"},{"key":"1346_CR33","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.1046\/j.1365-2168.2000.01581.x","volume":"87","author":"AB Williams","year":"2000","unstructured":"Williams AB, Cheetham MJ, Bartram CI, Halligan S, Kamm MA, Nicholls RJ, Kmiot WA. Gender differences in the longitudinal pressure profile of the anal canal related to anatomical structure as demonstrated on three-dimensional anal endosonography. Br J Surg. 2000;87:1674\u20139.","journal-title":"Br J Surg"},{"key":"1346_CR34","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1159\/000258662","volume":"81","author":"F Gundling","year":"2010","unstructured":"Gundling F, Seidl H, Scalercio N, Schmidt T, Schepp W, Pehl C. Influence of gender and age on anorectal function: normal values from anorectal manometry in a large caucasian population. Digestion. 2010;81:207\u201313.","journal-title":"Digestion"},{"issue":"5","key":"1346_CR35","first-page":"444","volume":"38","author":"RJ Felt-Bersma","year":"1991","unstructured":"Felt-Bersma RJ, Gort G, Meuwissen SG. Normal values in anal manometry and rectal sensation: a problem of range. Hepatogastroenterology. 1991;38(5):444\u20139.","journal-title":"Hepatogastroenterology"},{"key":"1346_CR36","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1002\/bjs.4394","volume":"91","author":"OM Jones","year":"2004","unstructured":"Jones OM, Brading AF, Mortensen NJ. Mechanism of action of botulinum toxin on the internal anal sphincter. Br J Surg. 2004;91:224\u20138.","journal-title":"Br J Surg"},{"key":"1346_CR37","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1056\/NEJM199907083410209","volume":"341","author":"M Hallett","year":"1999","unstructured":"Hallett M. One man\u2019s poison\u2013clinical applications of botulinum toxin. N Engl J Med. 1999;341:118\u201320.","journal-title":"N Engl J Med"},{"key":"1346_CR38","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1007\/s00384-005-0766-x","volume":"21","author":"P Katsinelos","year":"2006","unstructured":"Katsinelos P, Papaziogas B, Koutelidakis I, Paroutoglou G, Dimiropoulos S, Souparis A, Atmatzidis K. Topical 0.5% nifedipine vs lateral internal sphincterotomy for the treatment of chronic anal fissure: long-term follow-up. Int J Colorectal Dis. 2006;21:179\u201383.","journal-title":"Int J Colorectal Dis"},{"key":"1346_CR39","doi-asserted-by":"publisher","first-page":"6203","DOI":"10.3748\/wjg.v12.i38.6203","volume":"12","author":"P Katsinelos","year":"2006","unstructured":"Katsinelos P, Kountouras J, Paroutoglou G, Beltsis A, Chatzimavroudis G, Zavos C, Katsinelos T, Papaziogas B. Aggressive treatment of acute anal fissure with 0.5% nifedipine ointment prevents its evolution to chronicity. World J Gastroenterol. 2006;12:6203\u20136.","journal-title":"World J Gastroenterol"},{"key":"1346_CR40","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1007\/BF02236693","volume":"42","author":"C Antropoli","year":"1999","unstructured":"Antropoli C, Perrotti P, Rubino M, Martino A, De Stefano G, Migliore G, Antropoli M, Piazza P. Nifedipine for local use in conservative treatment of anal fissures: preliminary results of a multicenter study. Dis Colon Rectum. 1999;42:1011\u20135.","journal-title":"Dis Colon Rectum"},{"key":"1346_CR41","doi-asserted-by":"publisher","first-page":"1468","DOI":"10.1007\/s10350-004-6452-1","volume":"45","author":"P Perrotti","year":"2002","unstructured":"Perrotti P, Bove A, Antropoli C, Molino D, Antropoli M, Balzano A, De Stefano G, Attena F. Topical nifedipine with lidocaine ointment vs active control for treatment of chronic anal fissure: results of a prospective, randomized, double-blind study. Dis Colon Rectum. 2002;45:1468\u201375.","journal-title":"Dis Colon Rectum"},{"key":"1346_CR42","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1159\/000072715","volume":"20","author":"N A\u011fao\u011flu","year":"2003","unstructured":"A\u011fao\u011flu N, Cengiz S, Arslan MK, T\u00fcrkyilmaz S. Oral nifedipine in the treatment of chronic anal fissure. Dig Surg. 2003;20:452\u20136.","journal-title":"Dig Surg"},{"key":"1346_CR43","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1007\/s10350-004-6660-8","volume":"46","author":"T Ezri","year":"2003","unstructured":"Ezri T, Susmallian S. Topical nifedipine vs topical glyceryl trinitrate for treatment of chronic anal fissure. Dis Colon Rectum. 2003;46:805\u20138.","journal-title":"Dis Colon Rectum"},{"key":"1346_CR44","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1016\/S0741-5214(95)70064-1","volume":"22","author":"H Oshiro","year":"1995","unstructured":"Oshiro H, Kobayashi I, Kim D, Takenaka H, Hobson RW 2nd, Dur\u00e1n WN. L-type calcium channel blockers modulate the microvascular hyperpermeability induced by platelet-activating factor in vivo. J Vasc Surg. 1995;22:732\u20139; discussion 739-41.","journal-title":"J Vasc Surg"},{"key":"1346_CR45","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1254\/jjp.78.435","volume":"78","author":"Y Suzuki","year":"1998","unstructured":"Suzuki Y, Ishihara M, Segami T, Ito M. Anti-ulcer effects of antioxidants, quercetin, alpha-tocopherol, nifedipine and tetracycline in rats. Jpn J Pharmacol. 1998;78:435\u201341.","journal-title":"Jpn J Pharmacol"},{"key":"1346_CR46","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1097\/DCR.0b013e31827a7416","volume":"56","author":"SM Murad-Regadas","year":"2013","unstructured":"Murad-Regadas SM, Fernandes GO, Regadas FS, Rodrigues LV, Pereira Jde J, Regadas Filho FS, Dealcanfreitas ID, Holanda Ede C. How much of the internal sphincter may be divided during lateral sphincterotomy for chronic anal fissure in women? Morphologic and functional evaluation after sphincterotomy. Dis Colon Rectum. 2013;56:645\u201351.","journal-title":"Dis Colon Rectum"},{"key":"1346_CR47","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1016\/j.jcol.2014.05.006","volume":"34","author":"GO Fernandes","year":"2014","unstructured":"Fernandes GO, Murad-Regadas SM, Regadas FS, Rodrigues LV, Dealcanfreitas ID, Pereira JdJ, de Carvalho E, Regadas Filho FS. Clinical, functional and morphologic evaluation of patients undergoing lateral sphincterotomy for chronic anal fissure treatment. Identification of factors that can interfere with faecal continence. J Coloproctol (Rio J). 2014;34:174\u201380.","journal-title":"J Coloproctol (Rio J)."},{"key":"1346_CR48","doi-asserted-by":"publisher","DOI":"10.1007\/s13304-020-00874-8","author":"A Brillantino","year":"2020","unstructured":"Brillantino A, Izzo D, Iacobellis F, Maglio M, Grillo M, Vicenzo L, Bottino V, Renzi A. Safety and effectiveness of minimal sphincterotomy in the treatment of female patients with chronic anal fissure. Updates Surg. 2020. https:\/\/doi.org\/10.1007\/s13304-020-00874-8.","journal-title":"Updates Surg."},{"key":"1346_CR49","doi-asserted-by":"publisher","first-page":"1563","DOI":"10.1007\/DCR.0b013e3181f0869f","volume":"53","author":"E Hancke","year":"2010","unstructured":"Hancke E, Rikas E, Suchan K, V\u00f6lke K. Dermal flap coverage for chronic anal fissure: lower incidence of anal incontinence compared to lateral internal sphincterotomy after long-term follow-up. Dis Colon Rectum. 2010;53:1563\u20138.","journal-title":"Dis Colon Rectum"},{"key":"1346_CR50","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1007\/s00053-020-00470-9","volume":"42","author":"I Iesalnieks","year":"2020","unstructured":"Iesalnieks I. Kombinations therapie Fissurektomie und Botulinum toxin in der Behandlung der chronischen Analfissur. Coloproctology. 2020;42:464\u20138.","journal-title":"Coloproctology"},{"key":"1346_CR51","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1007\/s00384-010-0881-1","volume":"25","author":"W Chambers","year":"2010","unstructured":"Chambers W, Sajal R, Dixon A. V-Y advancement flap as first-line treatment for all chronic anal fissures. Int J Colorectal Dis. 2010;25:645\u20138.","journal-title":"Int J Colorectal Dis"},{"key":"1346_CR52","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1007\/s00268-009-9937-1","volume":"33","author":"P Giordano","year":"2009","unstructured":"Giordano P, Gravante G, Grondona P, Ruggiero B, Porrett T, Lunniss PJ. Simple cutaneous advancement flap anoplasty for resistant chronic anal fissure: a prospective study. World J Surg. 2009;33:1058\u201363.","journal-title":"World J Surg"},{"key":"1346_CR53","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1007\/s00053-020-00449-6","volume":"42","author":"E Hancke","year":"2020","unstructured":"Hancke E, Suchan K, V\u00f6lke K. Anokutaner advancement-flap zur sphinkterchonenden chirurgischen therapie der chronischen analfissur. Coloproctology. 2020;42:270\u20136.","journal-title":"Coloproctology"}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-021-01346-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12893-021-01346-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-021-01346-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T13:11:22Z","timestamp":1632489082000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcsurg.biomedcentral.com\/articles\/10.1186\/s12893-021-01346-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,24]]},"references-count":53,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1346"],"URL":"https:\/\/doi.org\/10.1186\/s12893-021-01346-5","relation":{},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,24]]},"assertion":[{"value":"10 February 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 September 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 September 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\u00a0The protocol for this study has been submitted to the Ethical Committee of our institution \u201cEthical Committee Palermo 1-AUOP P.Giaccone\u201d on the 1st of May 2020, which did not consider necessary to approve it and waved off, in that occasion, the requirement for ethical approval. Informed written consent was obtained from all individuals participants included in this study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The consent for publication has been obtained by all participants to the work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors report no conflict of interest in this work. The authors declare that they have no competing interests. This article has not been presented nor published elsewhere, and no financial support has been obtained in its preparation.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"350"}}