EFFICACY OF BOTULINUM TOXIN TYPE A IN THE TREATMENT OF CHRONIC ANAL FISSURE

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.

Download Full-text

CHRONIC ANAL FISSURE TREATMENT WITH BOTULINUM TOXIN TYPE A INJECTION

The American Journal of Gastroenterology ◽

10.14309/00000434-200410001-00330 ◽

2004 ◽

Vol 99 ◽

pp. S108

Author(s):

David M. Feldman ◽

Prem Chattoo ◽

Ali Khademi

Keyword(s):

Botulinum Toxin ◽

Anal Fissure ◽

Chronic Anal Fissure ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type

Download Full-text

THE TREATMENT OF CHRONIC ANAL FISSURES WITH FISSURE EXCISION AND BOTULINUM TOXIN TYPE A INJECTION (ISRCTN97413456)

Koloproktologia ◽

10.33878/2073-7556-2020-19-1-80-99 ◽

2020 ◽

Vol 19 (1) ◽

pp. 80-99 ◽

Cited By ~ 2

Author(s):

O. V. Tkalich ◽

A. A. Ponomarenko ◽

O. Yu. Fomenko ◽

K. I. Arslanbekova ◽

R. Yu. Khryukin ◽

...

Keyword(s):

Botulinum Toxin ◽

Anal Fissure ◽

Anal Sphincter ◽

Chronic Anal Fissure ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Main Group ◽

Control Group ◽

Pneumatic Balloon Dilatation

AIM: to assess the efficacy of botulinum toxin type A for chronic anal fissure.PATIENTS AND METHODS: the study included 80 patients randomized by random number generation in 2 groups. Forty patients underwent fissure excision in combination with injections of botulinum toxin type A into the internal sphincter (main group) and 40 – in combination with pneumatic balloon dilatation of the anal sphincter (control group).RESULTS: there were no statistically significant differences in the intensity of postoperative pain after defecation and during the day between the groups, p=0.45 and p=0.39, respectively. The groups were comparable in the complications such as perianal skin hematomas (p=0.84), external hemorrhoid thrombosis (p=0.1), urinary retention (p=0.46), long-term non-healing wounds (p=0.76). Transitory weakening of the anal sphincter was significantly more often in the control group. On day 30, the transitory anal incontinence in the main group was detected in 6 (21%), in the control group – in 18 (75%) patients, p=0.0002. On day 60, the weakness of the anal sphincter remained in the main group in 3 (10.7%), in the control group – in 10 (41%) patients, p=0.02.CONCLUSION: botulinum toxin type A and pneumatic balloon dilatation have equal effectiveness in the treatment of chronic anal fissure. The use of botulinum toxin type A can reduce the incidence of transitory weakening of the anal sphincter function in patients with chronic anal fissure.

Download Full-text