What is the best treatment for chronic anal fissures in adults?

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For medical treatments, topical nitroglycerin, topical calcium channel blockers, and botulinum toxin injections are effective in about half of patients but nitroglycerin has more adverse effects than the other agents and has a high recurrence rate in chronic anal fissure. Lateral internal sphincterotomy results in long-term cure rates of more than 90% and less than a 5% risk of incontinence (SOR: A, meta-analyses of RCTs). Medical therapies are usually recommended first, but lateral internal sphincterotomy is the treatment of choice for refractory anal fissures (SOR: C, expert opinion).

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