Reticular Meta-analysis of the efficacy evaluation of different surgical methods in the treatment of chronic anal fissure

Objective To evaluate the clinical effect of five surgical methods on chronic anal fissure. Methods Randomized controlled clinical trials of five surgical treatments for chronic anal fissure were performed by searching Chinese and foreign literature databases and related academic websites, including traditional anal fissure resection, longitudinal and transverse suture, modified longitudinal and transverse suture, and resection+internal/external sphincterotomy. The literature was screened according to the inclusion and exclusion criteria and data were extracted. The quality of the literature was assessed using the Jadad tool, Stata and GeMTC software. Results A total of twenty one randomized controlled clinical trials, 5 surgical procedures, and 2 430 participants were included. Reticular Meta-analysis showed that the cure rates of anal fissure resection+internal/external sphincterotomy were higher than those of traditional anal fissure resection. OR values were 2.27 (95%CI=1.14-4.36) and 3.26 (95%CI=1.67-6.75), respectively. The incidence of complications was the highest in longitudinal and transverse suture and traditional anal fissure resection, the lowest in resection+internal sphincterotomy. Conclusion In the evaluation of effectiveness and complication evaluation, the clinical effect of anal fissure resection + internal sphincterotomy is superior to the other 4 surgical methods. Key words: Fissure in ano; Surgical procedures, operative; Meta-analysis; Treatment outcome