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Video Surgery - Claudia Menconi at ESCP Barcelona 2014

Trainee Video Session - Carlo Ratto (Italy) at ESCP Nice 2018

Trainee Video Session - Lilli Lundby (Denmark) at ESCP Nice 2018

Trainee Video Session - David Zimmerman (The Netherlands) at ESCP Nice 2018

Trainee video session - Pasquale Giordano at ESCP Barcelona 2014

Sezai Leventoglu (Turkey) at ESCP Thessaloniki 2024

David Zimmerman (Netherlands) at ESCP Thessaloniki 2024

Debate - Sonia Ramamoorthy (USA) at ESCP Thessaloniki 2024

See also: EU view - Frederic Ris

Debate - Frederic Ris (Switzerland) at ESCP Thessaloniki 2024

See also: US view - Sonia Ramamoorthy

Christina Fleming (Ireland) at ESCP Thessaloniki 2024

Emma Carrington (United Kingdom) at ESCP Thessaloniki 2024

An anal fissure is a tear in the epithelial lining of the anal canal, distal to the dentate line. It is accompanied by a significant increase in the tone of the internal anal sphincter. Anal pain is usually intense, occurs during or minutes after a bowel movement, and can last from minutes to hours. It may be accompanied by minimal bleeding. A fissure is usually located in the posterior (in 90 % of cases) or anterior midline (in 10 % of women and 1–5 % of men with anal fissure). If there are multiple fissures or occur at a lateral position, other anal pathologies must be ruled out (e.g., tuberculosis, syphilis, HIV, Crohn’s disease). Treatment of anal fissure is based on general measures and pharmacological intervention. General measures consist of sitz baths, avoiding the presence of hard stools by using laxatives or significantly increasing fiber intake, and using analgesics. Pharmacological treatment is based on three groups: a nitric oxide donor (glyceryl trinitrate), calcium channel antagonists (diltiazem, nifedipine), and botulinum toxin. The results of these treatments are better than placebo but inferior to surgery. If these treatments fail, surgery is the best option. Sphincterotomy is an outpatient procedure with a success rate greater than 90 %, but it has a postoperative incontinence rate between 3 % and 15 %. A chance of postoperative incontinence is the main reason why drug treatment is now considered as the first therapeutic option, especially in patients with a high risk for incontinence.

While accidental anal and rectal trauma is relatively rare, iatrogenic injuries to this region – particularly the anus – are quite common. This chapter describes the most frequent etiologies of anal/rectal trauma and the basic clinical and instrumental investigations necessary to provide the most appropriate treatment, particularly in emergencies, when saving patient’s life is a surgeon’s primary concern.

The surgical management of anal and rectal trauma and retention of foreign bodies in the rectum is discussed using a dedicate algorithm. Finally, the possible functional consequences of these traumas are reviewed and how to preserve fecal continence and normal evacuation is described.

Oral poster - Michael Shapiro at ESCP Sorrento 2010

One of the Six Best Papers - Nick Battersby at ESCP Belgrade 2013

Global Reach Symposium - Gabrielle van Ramshorst (The Netherlands) at ESCP Thessaloniki 2024

Oral poster - Michael Dessily at ESCP Belgrade 2013

Free Paper - Juan García-Armengol at ESCP Copenhagen 2011

Free Papers (Functional) - Léon Maggiori at ESCP Dublin 2015

Free Paper (Functional) - Jean-Luc Faucheron at ESCP Dublin 2015

Free paper - Thomas Golda at ESCP Vienna 2012

Short Paper - Nigel Noor (UK) at Tripartite Colorectal Meeting 2014

Trials Methodology Symposium - Peer Wille-Jorgensen (Denmark) at ESCP Nice 2018

Free paper - Nick Battersby at ESCP Belgrade 2013

Global Reach symposium - Elizabeth Li, Felipe Bellolio Roth, Haron Nurhashim, Nicolas Luis Avellaneda, Olival Oliveira Junior, Simon Ng and Surendra Mantoo at ESCP Paris 2025

Global Reach symposium - Theophilus Teddy Kojo Anyomih at ESCP Paris 2025

Allied Health: Conservative treatment for faecal incontinence and evacuation difficulties

Meet the Experts - Gill Brook (UK) at Pelvic Floor Day, Tripartite Colorectal Meeting 2014

New Trials Forum - Anna Martling (Sweden) at ESCP Berlin 2017

One of the Six Best Papers - Matthew Kalady (USA) at Tripartite Colorectal Meeting 2014