Use of Botulinum Toxin Injections for the Treatment of Chronic Anal Fissure: Results From an American Society of Colon and Rectal Surgeons Survey

2021 ◽  
pp. 000313482110234
Author(s):  
Daniel J. Borsuk ◽  
Adam Studniarek ◽  
John J. Park ◽  
Slawomir J. Marecik ◽  
Anders Mellgren ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Anal Fissure ◽  
Online Survey ◽  
Chronic Anal Fissure ◽  
Internal Sphincter ◽  
Injection Technique ◽  
Expert Opinions ◽  
First Line Therapy ◽  
Colorectal Surgeons ◽  
American Society

Background Chronic anal fissure (CAF) is commonly treated by colorectal surgeons. Pharmacological treatment is considered first-line therapy. An alternative treatment modality is chemical sphincterotomy with injection of botulinum toxin (BT). However, there is a lack of a consensus on the BT administration procedure among colorectal surgeons. Methods A national survey approved by the American Society of Colon and Rectal Surgeons (ASCRS) Executive Council was sent to all members. An eight-question survey was sent via ASCRS email correspondence between December 2019 and February 2020. Questions were derived from available meta-analyses and expert opinions on BT use in CAF patients and included topics such as BT dose, injection technique, and concomitant therapies. The survey was voluntary and anonymous, and all ASCRS members were eligible to complete it. Responses were recorded and analyzed via an online survey platform. Results 216 ASCRS members responded to the survey and 90% inject 50-100U of BT. Most procedures are performed under MAC anesthesia (56%). A majority of respondents (64%) inject into the internal sphincter and a majority (53%) inject into 4 quadrants in the anal canal circumference. Some respondents perform concomitant manual dilatation (34%) or fissurectomy (38%). Concomitant topical muscle relaxing agents are not used uniformly among respondents. Discussion Injection of BT for CAF is used commonly by colorectal surgeons. There is consensus on BT dosage, administration site, technique, and the use of monitored anesthesia care.

Botulinum Toxin A with Fissurectomy is a Viable Alternative to Lateral Internal Sphincterotomy for Chronic Anal Fissure

2009 ◽  
Vol 75 (10) ◽  
pp. 925-928 ◽  
Author(s):  
Ohara Aivaz ◽  
Jessica Rayhanabad ◽  
Vincent Nguyen ◽  
Philip I. Haigh ◽  
Maher Abbas
Keyword(s):  
Botulinum Toxin ◽  
Fecal Incontinence ◽  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Botulinum Toxin A ◽  
Internal Sphincter ◽  
Viable Alternative ◽  
Lateral Internal Sphincterotomy ◽  
Toxin A ◽  
Internal Sphincterotomy

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.

Lack of efficacy of botulinum toxin in chronic anal fissure

2000 ◽  
Vol 118 (4) ◽  
pp. A176 ◽  
Author(s):  
Laurent Siproudhis ◽  
Veronique Sebille ◽  
Francois Pigot ◽  
Philippe Hemery ◽  
Frederic Juguet ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Anal Fissure ◽  
Chronic Anal Fissure

scholarly journals BOTULINUM TOXIN TYPE A AND LATERAL SUBCUTANEOUS SPHINCTEROTOMY FOR CHRONIC ANAL FISSURE WITH THE SPHINCTER SPASM. WHAT TO CHOOSE? (systematic literature review and meta-analysis)

2020 ◽  
Vol 19 (2) ◽  
pp. 113-128 ◽  
Author(s):  
R. Yu. Khryukin ◽  
I. V. Kostarev ◽  
K. I. Arslanbekova ◽  
M. A. Nagudov ◽  
E. E. Zharkov
Keyword(s):  
Botulinum Toxin ◽  
Postoperative Complications ◽  
Anal Fissure ◽  
Anal Incontinence ◽  
Chronic Anal Fissure ◽  
Meta Analysis ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Results Of Treatment

INTRODUCTION: for the treatment of chronic anal fissure, various surgical techniques are used, the main difference between which is the method of eliminating the anal sphincter spasm. One of the most serious postoperative complications is the development of anal incontinence. To date, there are a number of methods for drug-induced relaxation of the internal sphincter, which can significantly reduce the risk of developing anal incontinence after surgery.AIM: to evaluate the safety and effectiveness of botulinum toxin type A (BTA) and lateral subcutaneous sphincterotomy (LSS) in the treatment of chronic anal fissure with sphincter spasm.METHODS: a systematic review and meta-analysis of 7 selected randomized clinical trials comparing the results of treatment of chronic anal fissure using BTA and LSS was performed. The results of treatment of 489 patients were analyzed with an assessment of the following indicators: the incidence of epithelization of fissures, postoperative complications, development of anal incontinence and the disease recurrence. RESULTS: In the BTA group, the incidence of fissure epithelization is 0.88 times lower than in the LSS group (OR=0.12; CI=0.06;0.22; p<0.00001). There were no statistical differences in the rate of postoperative complications in both groups (OR=1.07; CI=0.50;2.30; p=0.85). The risk of developing postoperative anal incontinence is 0.86 times lower in the BTA group than in the LSS group (OR=0.14; CI=0.03;0.64; p=0.01). The risk of relapse after lateral subcutaneous sphincterotomy is 6.06 times lower than when using botulinum toxin type A (OR=6.06; CI=3.52;10.42; p<0.00001).CONCLUSION The use of botulinum toxin type A in the treatment of chronic anal fissure reduces the risk of developing postoperative anal incontinence, but this method is significantly inferior to lateral subcutaneous sphincterotomy in terms of the rate of chronic anal fissure epithelization.

scholarly journals Botulinum toxin injection versus internal anal sphincterotomy for the treatment of chronic anal fissure

2005 ◽  
Vol 25 (2) ◽  
pp. 140-142 ◽  
Author(s):  
Baghai-Wadji Massoud ◽  
Vahedian Mehrdad ◽  
Tolooie Baharak ◽  
Zohoor Alireza
Keyword(s):  
Botulinum Toxin ◽  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Botulinum Toxin Injection

scholarly journals 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

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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