Isosorbide dinitrate ointmentvsbotulinum toxin A (Dysport®) as the primary treatment for chronic anal fissure: a randomized multicentre study

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.

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Fissurectomy combined with botulinum toxin A: a review of short- and long-term efficacy of this treatment strategy for chronic anal fissure; a consecutive proposal of a treatment algorithm for chronic anal fissure

coloproctology ◽

10.1007/s00053-020-00480-7 ◽

2020 ◽

Vol 42 (5) ◽

pp. 400-408

Author(s):

M. Trzpis ◽

J. M. Klaase ◽

R. H. Koop ◽

P. M. A. Broens

Keyword(s):

Botulinum Toxin ◽

Anal Fissure ◽

Recurrence Rate ◽

Treatment Strategy ◽

Chronic Anal Fissure ◽

Botulinum Toxin A ◽

Toxin A ◽

Term Efficacy ◽

Short And Long Term

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.

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Treatment of chronic anal fissure with isosorbide dinitrate

Diseases of the Colon & Rectum ◽

10.1007/bf02237057 ◽

1998 ◽

Vol 41 (11) ◽

pp. 1406-1410 ◽

Cited By ~ 24

Author(s):

Joseph Lysy ◽

Yardena Israelit-Yatzkan ◽

Mirna Sestiere-Ittah ◽

Daniel Keret ◽

Eran Goldin

Keyword(s):

Anal Fissure ◽

Isosorbide Dinitrate ◽

Chronic Anal Fissure

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Treatment of Chronic Anal Fissure

Journal of Surgical Sciences ◽

10.3329/jss.v19i2.43987 ◽

2019 ◽

Vol 19 (2) ◽

pp. 67-71

Author(s):

Abdullah Al Tarique ◽

Md Manjur Alam

Keyword(s):

Anal Fissure ◽

Chronic Anal Fissure ◽

Treatment Options ◽

Dentate Line ◽

Primary Treatment ◽

Treatment Modalities ◽

Healing Ulcer ◽

Recurrence Rates ◽

Support Device ◽

Perineal Support

Chronic anal fissure is a non healing ulcer in the anoderm appearing as a painful tear below the dentate line. There are debates about the efficacy of different treatment options for chronic anal fissure. This review aims to evaluate existing and newer treatment modalities. Aspects of chronic anal fissure aetiology and pathogenesis are also reviewed. Glyceryl trinitrate (GTN) ointment, Diltiazem ointment can be used as first line and Botulinum toxin (BTX) injection as second line pharmacological treatment. The effects of these chemicals are not permanent with higher fissure recurrence rates. Lateral internal sphincterotomy is the operative treatment of choice for fissures with high anal tone. Flap anoplasty should be done for fissures with normal anal tone especially in female patients. Both surgical procedures can be used as primary treatment option. The newer treatment options like gonyautoxin, controlled balloon anal dilatation, closed anal spand fissurotomy need more research. Perineal support device can be used as an adjunct to other treatment modalities. Journal of Surgical Sciences (2015) Vol. 19 (2) : 67-71

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