Partial Lateral Internal Sphincterotomy versus Combined Botulinum Toxin A Injection and Topical Diltiazem in the Treatment of Chronic Anal Fissure

2015 ◽  
Vol 58 (2) ◽  
pp. 228-234 ◽  
Author(s):  
Hossein Gandomkar ◽  
Atefeh Zeinoddini ◽  
Reza Heidari ◽  
Hadi Ahmadi Amoli
2009 ◽  
Vol 75 (10) ◽  
pp. 925-928 ◽  
Author(s):  
Ohara Aivaz ◽  
Jessica Rayhanabad ◽  
Vincent Nguyen ◽  
Philip I. Haigh ◽  
Maher Abbas

Lateral internal sphincterotomy (LIS) is the gold standard surgical treatment for anal fissure. However, it carries potential complications, including fecal incontinence. The goal of this retrospective study was to compare the outcome of botulinum toxin A injection coupled with fissurectomy ([BTX + FIS) versus LIS. There were 59 patients who underwent BTX + FIS or LIS over a 5-year period. LIS was performed in the standard fashion without fissurectomy. BTX + FIS entailed internal sphincter injection with 80 units of botulinum toxin A coupled with fissurectomy. Forty patients underwent LIS and 19 had BTX + FIS. The choice of operation was based on the patient's preference. Primary healing rate was 90 and 74 per cent in the LIS and BTX + FIS groups, respectively ( P = 0.13). The complication rate was 10 per cent in the LIS vs 0 per cent in the BTX + FIS groups ( P = 0.29). Complications of LIS included anal sepsis in one patient and flatal and/or fecal incontinence in three patients. During a mean follow up of 19 months; recurrence rate was 0 and 5 per cent in the LIS and BTX+FIS groups, respectively ( P = 0.32). The results of this study demonstrate that BTX + FIS is a viable alternative to LIS for patients with chronic anal fissure and should be considered as an alternative first-line surgical therapy.


2020 ◽  
Vol 42 (5) ◽  
pp. 400-408
Author(s):  
M. Trzpis ◽  
J. M. Klaase ◽  
R. H. Koop ◽  
P. M. A. Broens

Abstract Background Several studies have investigated the short- and long-term efficacy of fissurectomy combined with botulinum toxin A injection for patients with chronic anal fissure. Objective To evaluate the short- and long-term efficacy of the combined treatment strategy of fissurectomy with botulinum toxin A for chronic anal fissure and to discuss recurrence rates in the light of current theory on the aetiology of anal fissure. Materials and methods This is a narrative review. We conducted an article search using PubMed and calculated the means of the reported efficacy ranges. Results Fissurectomy combined with botulinum toxin A injections freed at least 78% of the patients from symptoms and yielded a fissure healing rate of up to 86%. Within 12 months after treatment a 3% recurrence rate was reported. On average, the long-term recurrence rate was 22%. One study reported a 50% recurrence rate 22 months after treatment. Conclusion The efficacy of fissurectomy combined with botulinum toxin A injection for chronic anal fissure is high. The short-term recurrence rate is low, while long-term recurrence is relatively high. Extended follow-up indicates that recurrence of chronic anal fissure is possibly caused by anal basal pressure building up steadily once again. If so, the cause of renewed increase of pressure should be addressed. Based on the literature and on our clinical experience, we assume that the underlying cause of increasing anal basal pressure is that patients use their pelvic floor muscles inadequately and this in turn leads to chronic anal fissure.


2006 ◽  
Vol 49 (4) ◽  
pp. 427-432 ◽  
Author(s):  
Paola De Nardi ◽  
Enrico Ortolano ◽  
Giovanni Radaelli ◽  
Carlo Staudacher

2004 ◽  
Vol 47 (11) ◽  
pp. 1947-1952 ◽  
Author(s):  
Ian Lindsey ◽  
Chris Cunningham ◽  
Oliver M. Jones ◽  
Chris Francis ◽  
Neil J. McC. Mortensen

2021 ◽  
Vol 25 (2) ◽  
pp. 513-519
Author(s):  
Abdulqadir Zngana ◽  
Bawan Hiwa

Background and objective: The gold standard for the treatment of chronic anal fissure is lateral internal sphincterotomy. Botulinum toxin injection provides temporary alleviation of sphincter spasm and allows the fissure to heal. This study aimed to compare the outcomes of lateral internal sphincterotomy and botulinum toxin injection treatments in patients with uncomplicated chronic anal fissure. Methods: A prospective comparative study was carried out at the surgical unit of Erbil teaching hospital, Erbil, Kurdistan Region of Iraq, from January 2017 to February 2018. Fifty-five patients were enrolled in this study. Five patients were excluded, and the remaining 50 patients were equally divided into two groups. Group A was managed with lateral internal sphincterotomy and group B with botulinum toxin. Postoperative pain relief, bleeding, fissure healing, incontinence, and relapse after six weeks and three months of follow-up were compared. Results: One month after treatment, 12% of the lateral internal sphincterotomy group had bleeding, while none of the botulinum toxin group (P = 0.234). Two patients (8%) of the lateral internal sphincterotomy group had pain while one (4%) of the botulinum toxin group (P >0.999).Three months after treatment, 4% of the lateral internal sphincterotomy group had bleeding, while none of the botulinum toxin group (P >0.999). None of the lateral internal sphincterotomy group had pain while one (4%) of the botulinum toxin group (P >0.999). Regarding healing, 96% of the lateral internal sphincterotomy group healed, while 92% in the botulinum toxin group (P >0.999). Conclusion: The outcome of lateral internal sphincterotomy and botulinum toxin were nearly the same, but lateral internal sphincterotomy required hospitalization, period off work, and risk of anesthesia. These risks were absent in botulinum toxin injection. Keywords: Chronic anal fissure; Lateral internal sphincterotomy; Botulinum toxin; Complications.


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