{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:17:20Z","timestamp":1773274640047,"version":"3.50.1"},"reference-count":51,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Anal fissures are a common condition in the general population, for which there are multiple treatment options. It is essential to select the most appropriate treatment for the right patient. This study aimed to observe and evaluate the effect of topical antibiotherapy, which is widely used in the management of wounds and chronic infections, on the healing of acute and chronic anal fissures. Materials and Methods: Hospital records of 625 individuals diagnosed with an anal fissure were reviewed. Previous treatments, including 0.4% glyceryl trinitrate and 5% lidocaine, were recorded. A total of 118 patients were included: 49 patients who received additional topical metronidazole due to inflammation, induration and minimal purulent discharge, in the absence of an abscess; and 69 uncomplicated patients who received only standard treatment, as per the exclusion criteria. Results: The mean age of the participants was 41.06 \u00b1 10.70 years. No significant differences were found between the groups regarding age or sex (p = 0.616 and p = 0.665, respectively). However, prior treatment history and mucosal healing differed significantly between the two groups (p = 0.001 and p = 0.024, respectively). There were no significant differences in follow-up intervals, additional treatment requirements or improvement in VAS scores (p = 0.546, 0.904 and 0.154, respectively). Conclusions: Topical metronidazole may be associated with improved mucosal healing in selected patients with acute anal fissures presenting with clinical features such as local inflammation, minimal discharge or incision-related changes. However, the observed benefit does not appear to be uniform across all patients, and, in the absence of microbiological data, the extent of microbial involvement remains uncertain. Accordingly, topical metronidazole may be considered for carefully selected cases of acute anal fissure based on clinical judgement, while avoiding routine or indiscriminate antibiotic use.<\/jats:p>","DOI":"10.3390\/medicina62030490","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T11:52:11Z","timestamp":1772711531000},"page":"490","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of Treatment Effectiveness in Acute and Chronic Anal Fissures"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8956-351X","authenticated-orcid":false,"given":"Onur \u0130lkay","family":"Din\u00e7er","sequence":"first","affiliation":[{"name":"Department of General Surgery, Istinye University Medical Park Antalya Hospital, 07000 Antalya, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7689-4552","authenticated-orcid":false,"given":"Duygu","family":"Felek","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Yozgat Bozok University, 66100 Yozgat, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6468-3483","authenticated-orcid":false,"given":"Erol","family":"Cakmak","sequence":"additional","affiliation":[{"name":"Department of Gastroentrology, Faculty of Health Sciences, Fenerbahce University, 34000 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vugar Ali","family":"Turksoy","sequence":"additional","affiliation":[{"name":"Department of Public Health, Faculty of Medicine, Yozgat Bozok University, 66100 Yozgat, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"275","DOI":"10.3393\/ac.2020.00976.0139","article-title":"Minimal lateral internal sphincterotomy (LIS): Is it enough to cut less than the conventional tailored LIS?","volume":"37","author":"Lee","year":"2021","journal-title":"Ann. Coloproctol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1111\/codi.14466","article-title":"Treatment of anal fissure: A survey of surgical practice in Australia and New Zealand","volume":"21","author":"Siddiqui","year":"2019","journal-title":"Colorectal Dis."},{"key":"ref_3","unstructured":"Corman, M.M.L., Roberto, C.M., Bergamaschi, R., Nicholls, J., and Fazio, V.W. (2010). Anatomy and embryology of the anus, rectum, and colon. Corman\u2019s Colon and Rectal Surgery, Lippincott Williams & Wilkins. [6th ed.]."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1308\/003588407X205576","article-title":"Towards safer treatments for benign anorectal disease: The pharmacological manipulation of the internal anal sphincter","volume":"89","author":"Jones","year":"2007","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1038\/sj.bjp.0705348","article-title":"Acetylcholine and tachykinins involvement in the caffeine-induced biphasic change in intracellular Ca2+ in bovine airway smooth muscle","volume":"139","author":"Carbajal","year":"2003","journal-title":"Br. J. Pharmacol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Saygili, S., Hegde, S., and Shi, X.Z. (2024). Effects of Coffee on Gut Microbiota and Bowel Functions in Health and Diseases: A Literature Review. Nutrients, 16.","DOI":"10.3390\/nu16183155"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1007\/s10350-008-9271-y","article-title":"Effects of Caffeine on Anorectal Manometric Findings","volume":"51","author":"Lohsiriwat","year":"2008","journal-title":"Dis. Colon Rectum"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Hegde, S., Shi, D.W., Johnson, J.C., Geesala, R., Zhang, K., Lin, Y.M., and Shi, X.Z. (2022). Mechanistic study of coffee effects on gut microbiota and motility in rats. Nutrients, 14.","DOI":"10.3390\/nu14224877"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"138","DOI":"10.3393\/ac.2017.06.08","article-title":"Clinical characteristics and incidence of perianal diseases in patients with ulcerative colitis","volume":"34","author":"Choi","year":"2018","journal-title":"Ann. Coloproctol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1055\/s-0037-1609026","article-title":"Anorectal complaints: Hemorrhoids, fissures, abscesses, fistulae","volume":"31","author":"Jamshidi","year":"2018","journal-title":"Clin. Colon Rectal Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Riboni, C., Selvaggi, L., Cantarella, F., Podda, M., Bracchitta, S., Mosca, V., Cosenza, A., Cosenza, V., Selvaggi, F., and Nardo, B. (2024). Anal Fissure and Its Treatments: A Historical Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13133930"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.bpg.2009.06.002","article-title":"The physiology of continence and evacuation","volume":"23","author":"Bajwa","year":"2009","journal-title":"Best Pract. Res. Clin. Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1055\/s-0035-1570390","article-title":"Anal fissure","volume":"29","author":"Beaty","year":"2016","journal-title":"Clin. Colon Rectal Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"115","DOI":"10.3393\/ac.2020.03.16","article-title":"The long-term effect of standardized anal dilatation for chronic anal fissure on anal continence","volume":"37","author":"Pinsk","year":"2021","journal-title":"Ann. Coloproctol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1007\/s10151-017-1664-2","article-title":"A systematic review and meta-analysis of the treatment of anal fissure","volume":"21","author":"Nelson","year":"2017","journal-title":"Tech. Coloproctol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1007\/DCR.0b013e3181f0869f","article-title":"Dermal flap coverage for chronic anal fissure: Lower incidence of anal incontinence compared to lateral internal sphincterotomy after long-term follow-up","volume":"53","author":"Hancke","year":"2010","journal-title":"Dis. Colon Rectum"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1007\/s12262-015-1319-3","article-title":"Local and oral antibiotics with avoidance of constipation (LOABAC) treatment for anal fissure: A new concept in conservative management","volume":"78","author":"Garg","year":"2016","journal-title":"Indian J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.suc.2023.11.001","article-title":"Management of hemorrhoids and anal fissures","volume":"104","author":"Akinmoladun","year":"2024","journal-title":"Surg. Clin. N. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/SLA.0b013e318225178a","article-title":"Topical diltiazem cream versus botulinum toxin A for the treatment of chronic anal fissure: A double-blind randomized clinical trial","volume":"255","author":"Samim","year":"2012","journal-title":"Ann. Surg."},{"key":"ref_20","first-page":"112","article-title":"Long-term prospective randomised clinical and manometric comparison between surgical and chemical sphincterotomy for treatment of chronic anal fissure","volume":"47","author":"Othman","year":"2009","journal-title":"S. Afr. J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.cjtee.2021.07.004","article-title":"Therapeutic strategies for chronic wound infection","volume":"25","author":"Liu","year":"2022","journal-title":"Chin. J. Traumatol."},{"key":"ref_22","first-page":"286","article-title":"Could local antibiotics be included in the treatment of acute anal fissure?","volume":"34","author":"Karapolat","year":"2018","journal-title":"Turk J. Surg."},{"key":"ref_23","unstructured":"Gerbasi, L., and Ashurst, J.V. (2026, February 26). Anal fissures, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK526063\/."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.suc.2025.08.002","article-title":"Anal fissures","volume":"106","author":"Chiu","year":"2025","journal-title":"Surg. Clin. N. Am."},{"key":"ref_25","first-page":"279","article-title":"Management of anal fissure","volume":"73","author":"Higuero","year":"2023","journal-title":"Rev. Prat."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1007\/s10151-025-03162-y","article-title":"The 5-year outcomes and predictors of healing in chronic anal fissure treated with botulinum toxin: A retrospective analysis of 199 cases","volume":"29","author":"Arslan","year":"2025","journal-title":"Tech. Coloproctol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.47391\/JPMA.9726","article-title":"Comparison of outcome of botulinum toxin injection with and without glyceryl trinitrate in chronic anal fissure in terms of postoperative pain and healing","volume":"74","author":"Hussain","year":"2024","journal-title":"J. Pak. Med. Assoc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s10151-025-03189-1","article-title":"Long-term incontinence rates after traditional lateral internal sphincterotomy: A 5-year retrospective analysis from a high-volume tertiary referral center for proctologic disorders","volume":"29","author":"Salvatore","year":"2025","journal-title":"Tech. Coloproctol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jviscsurg.2021.07.002","article-title":"Modified open posterior internal sphincterotomy with sliding skin graft for chronic anal fissure and anal stenosis: Low recurrence rate and no serious faecal incontinence postoperative complication","volume":"159","author":"Iida","year":"2022","journal-title":"J. Visc. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1111\/ans.14292","article-title":"Combined treatment approach to chronic anal fissure with associated anal fistula","volume":"88","author":"FitzDowse","year":"2018","journal-title":"ANZ J. Surg."},{"key":"ref_31","first-page":"e920243","article-title":"Analysis of Risk Factors for Anorectal Stenosis of Perianal Fistulizing Crohn\u2019s Disease","volume":"26","author":"Xu","year":"2020","journal-title":"Med. Sci. Monit."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.jped.2017.01.005","article-title":"Water and fluid intake in the prevention and treatment of functional constipation in children and adolescents: Is there evidence?","volume":"93","author":"Boilesen","year":"2017","journal-title":"J. Pediatr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1046\/j.1440-1754.2003.00152.x","article-title":"Cow\u2019s milk consumption in constipation and anal fissure in infants and young children","volume":"39","author":"Andiran","year":"2003","journal-title":"J. Paediatr. Child Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1055\/s-0041-1740037","article-title":"Anorectal Strictures in Complex Perianal CD: How to Approach?","volume":"35","author":"Lightner","year":"2022","journal-title":"Clin. Colon Rectal Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1111\/codi.16248","article-title":"Anoplasty for Anatomical Anal Stenosis: Systematic Review of Complications and Recurrences","volume":"24","author":"Gallo","year":"2022","journal-title":"Colorectal Dis."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Wen, C.-C., Huang, S.-M., and Wang, Y.-W. (2024). Anatomical Anal Stenosis after PPH: Insights from a Retrospective Study and Rat Model. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25063543"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e35160","DOI":"10.1097\/MD.0000000000035160","article-title":"The effect of caudal epidural injection on healing in the treatment of chronic anal fissure","volume":"102","year":"2023","journal-title":"Medicine"},{"key":"ref_38","first-page":"e30530","article-title":"Lateral internal anal sphincterotomy of chronic anal fissure: An experience of 165 cases","volume":"14","year":"2022","journal-title":"Cureus"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.jviscsurg.2023.03.003","article-title":"Fissurectomy with mucosal advancement flap anoplasty: The end of a dogma?","volume":"160","author":"Skoufou","year":"2023","journal-title":"J. Visc. Surg."},{"key":"ref_40","first-page":"1","article-title":"Benign anorectal diseases and obsessive symptoms: A holistic analysis of psychological and lifestyle factors\u2014A prospective case-control study","volume":"31","author":"Esen","year":"2025","journal-title":"Psychol. Health Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1007\/s10151-025-03129-z","article-title":"Fissurectomy with or without anoplasty for chronic anal fissures is a valid alternative to lateral internal sphincterotomy: A retrospective cohort study of 475 patients","volume":"29","author":"Gallo","year":"2025","journal-title":"Tech. Coloproctol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"200223","DOI":"10.1098\/rsob.200223","article-title":"Wound healing: Cellular mechanisms and pathological outcomes","volume":"10","author":"Wilkinson","year":"2020","journal-title":"Open Biol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1111\/bjd.13954","article-title":"Cellular and molecular mechanisms of repair in acute and chronic wound healing","volume":"173","author":"Martin","year":"2015","journal-title":"Br. J. Dermatol."},{"key":"ref_44","first-page":"837","article-title":"Novel use of povidone iodine in fissure-in-ano","volume":"51","author":"Durai","year":"2010","journal-title":"Singapore Med. J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"131","DOI":"10.3393\/ac.2021.00675.0096","article-title":"The importance of topical metronidazole in the treatment of acute anal fissure: A double-blind study controlled for prospective randomization","volume":"39","author":"Mert","year":"2023","journal-title":"Ann. Coloproctol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s13304-011-0077-4","article-title":"Care with regard to details improves the outcome of Longo mucoprolapsectomy: Long term follow up","volume":"63","author":"Calomino","year":"2011","journal-title":"Updates Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00384-022-04292-7","article-title":"Pelvic floor physical therapy in patients with chronic anal fissure: Long-term follow-up of a randomized controlled trial","volume":"38","author":"Elzevier","year":"2023","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1007\/s12262-014-1080-z","article-title":"Randomised prospective controlled trial of topical 2% diltiazem versus lateral internal sphincterotomy for the treatment of chronic fissure in ano","volume":"77","author":"Vaithianathan","year":"2015","journal-title":"Indian J. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"304","DOI":"10.4103\/ejs.ejs_284_23","article-title":"Efficacy of local metronidazole with glyceryl trinitrate versus topical glyceryl trinitrate alone in the treatment of acute anal fissure: A randomized clinical trial","volume":"43","author":"Elgendy","year":"2024","journal-title":"Egypt. J. Surg."},{"key":"ref_50","first-page":"e31812","article-title":"Comparative efficacy of topical metronidazole and glyceryl trinitrate versus topical glyceryl trinitrate alone in the treatment of acute anal fissure: A randomized clinical trial","volume":"14","author":"Shahid","year":"2022","journal-title":"Cureus"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1007\/s12664-015-0559-2","article-title":"The effects of topical application of metronidazole for treatment of chronic anal fissure: A randomized, controlled pilot study","volume":"34","author":"Grekova","year":"2015","journal-title":"Indian J. Gastroenterol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/490\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T09:54:26Z","timestamp":1773222866000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/490"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,5]]},"references-count":51,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["medicina62030490"],"URL":"https:\/\/doi.org\/10.3390\/medicina62030490","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,5]]}}}