TREATMENT OF ANAL FISSURE WITH LASER – A MINIMALLY INVASIVE OPTION FOR PAIN MANAGEMENT IN ANAL FISSURES? A BRAZILIAN MULTICENTER STUDY
Bibliographic record
Abstract
Introduction Anal fissure (AF) is a common condition in proctologists' offices. Although internal lateral sphincterotomy remains the gold standard surgery for chronic AF, it still has a considerable rate of anal incontinence. The aim of this study is to describe an alternative and minimally invasive technique for the treatment of AF using photobiomodulation and high-power laser (Laser Fissure Treatment - LFT), and to present the initial results, primarily evaluating pain relief in both acute and chronic AF. Methods A retrospective study was conducted with 38 patients treated on an outpatient basis with LFT in three different hospitals across different states in Brazil (Santa Catarina, Paraná, and São Paulo). The objective was to assess the effects of LFT treatment on pain and incontinence rates in patients with AF after the procedure. The Wilcoxon test was used to identify the effects of LFT treatment over time (D0, D7, D15, D30, and D60). For post-operative pain intensity, the Visual Analog Scale (VAS) was used; and for the analysis of anal incontinence, the Wexner scale was applied. Results Of the patients, 65.79% (n=25) were male. The median age was 49 years. Constipation was reported by 31.5%; 13% were smokers, and 21% had recently used opioids. In 92.1% of cases, AF was located posteriorly. Skin tags were present in 26.9%, and 21% had recently undergone prior anal surgeries. A significant reduction in pain over time was observed, with post-operative pain intensity measured by the VAS. Before surgery (D0), the average VAS score was 4.08, progressively decreasing to 0.06 by day 60 post-operatively (P < 0.05). No significant changes in fecal continence were observed by the end of the 60-day follow-up period. Complications occurred in 3 patients (1 hemorrhoidal thrombosis, 1 skin tag, and 1 “failure”). The recurrence rate was low, with only one reported case. Satisfaction after 90 days was present in 93.6%. Conclusion The results suggest that the treatment of anal fissure with laser therapy leads to a significant reduction in pain intensity over time, without affecting anal continence. Publication History Article published online: 25 April 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".