Abstract
<jats:p>Chronic anal fissure is a common proctological condition characterized by severe pain and a substantial reduction in quality of life. Despite the availability of various treatment modalities, rates of incomplete healing and recurrence remain high, underscoring the multifactorial nature of the disease and the necessity to identify determinants of treatment effectiveness. Objective. To identify factors associated with complete healing of chronic anal fissures at week 4 of treatment. The study was conducted in accordance with ethical standards and principles governing medical research involving human subjects. The work was performed under the departmental research project “Development and improvement of methods for diagnosis, surgical treatment, and rehabilitation of patients with pathologies of the digestive tract and perineum,” implementation period 2024–2026, state registration number 0123U1051738. Materials and methods. This prospective single-center study analyzed 155 patients with chronic anal fissures treated between 2022 and 2024. Univariate and multivariate analyses, including odds ratio regression, were performed to identify factors influencing complete defect healing at week 4. Patients were stratified into two subgroups according to treatment strategy: personalized management algorithm (n = 83) and standardized therapy (n = 72). The study was conducted in accordance with the principles of the Helsinki Declaration. All patients provided informed consent to participate in the study. The study protocol was approved by the Bioethics Committee of the Bogomolets National Medical University (protocol No. 2 dated October 17, 2022). Statistical processing was performed using IBM SPSS Statistics Base v.22, R-Statistics v.3.2.0, and Medstat software. Standard methods of variational statistics were applied. The work was performed as part of the departmental research project entitled “Development and improvement of methods for diagnosis, surgical treatment, and rehabilitation of patients with pathologies of the digestive tract and perineum”, implementation period 2024–2026, state registration number 0123U1051738. The work was performed under the departmental research project “Development and improvement of methods for diagnosis, surgical treatment, and rehabilitation of patients with pathologies of the digestive tract and perineum,” implementation period 2024–2026, state registration number 0123U1051738. Results. Complete healing was achieved in 128 (82.6%) patients. The personalized target-to-treat algorithm significantly increased the likelihood of healing compared with standardized therapy (92.1% vs 71.8%; p < 0.001). In multivariate analysis, independent predictors of complete healing were treatment type (OR = 4.31; 95% CI 1.63–11.41; p = 0.003) and disease duration (OR = 0.73; 95% CI 0.61–0.87; p = 0.001). Age, gender, fissure location, pain intensity, and presence of concomitant pathology had no independent effect on treatment outcome. The predictive performance of the model was excellent (AUC = 0.97). Conclusions. The principal factors influencing complete healing of chronic anal fissures at week 4 of treatment are the treatment strategy and disease duration. Implementation of a personalized target-to-treat algorithm reliably improves treatment efficacy and can be recommended for clinical practice.</jats:p>