An anal fissure (AF) is a longitudinal tear or defect in the skin of the anal canal distal to the dentate line, and it is the second most common reason for proctologic consultation after hemorrhoidal disease. While standardized anal dilatation is a reliable and well-established technique, balloon dilatation therapy, although reported as effective, is often used as a last resort and remains limited, because there is a scarcity of recent in-depth studies on this technique. Hence, this study aims to investigate the efficacy of balloon dilatation in the treatment of chronic anal fissures.

In this study, we included patients with chronic anal fissures who experienced rectal pain lasting more than 6 weeks, bleeding, and resistance to local treatments. Initially, recto sigmoidoscopy was performed, followed by anoscope insertion to locate and measure the length of the fissures. Subsequently, a 35 mm achalasia balloon was introduced through the anoscope. The balloon was inflated gradually, starting at 1 pascal and increasing to 5-7 pascals until reaching 35 mm, remaining in this state for 4 minutes before gradual deflation and removal. Patients were evaluated using the REALISE score questionnaire before the intervention, one month after, and six months after, assessing anal pain, bleeding, stool quality, painkiller usage, and quality of life. Additionally, we investigated potential complications.

Our study consisted of 38 patients with a mean age of 49.05±12.41 years, with 60.5% female participants. The initial mean pre-intervention REALISE score was 11.24±4.59, which significantly reduced after one month to 2.92±1.42 (p<0.001) and continued to plummet to 0.92±1.12 (p<0.001) in the sixth-month evaluation. Notably, the REALISE score declined significantly from the first to the sixth month (p<0.001) of intervention. Subsequent sub-population analysis unveiled a prominently significant reduction among more severe patients with pre-intervention REALISE scores above 10. No bleeding or tearing occurred.

The findings from this study affirm the efficacy of balloon dilatation in the treatment of chronic anal fissure patients, especially in cases of high severity. Significantly, this improvement continues over time, suggesting that balloon dilatation could be an effective approach for managing anal fissures in patients unresponsive to other treatments.