Abstract | BACKGROUND:
Sphincterotomy has been the most commonly used treatment for chronic anal fissures. Although effective it is associated with incontinence (0-20%). Intrasphincteric Botulinum Toxin A injection seems to be a reliable option. The aim of this clinical report is to verify the effectiveness of this treatment in relieving symptoms and healing fissures without relapse. METHODS: The study design was an open label non-comparative prospective trial to evaluate the efficacy ofbotulinum toxin injection in anal sphincters. In the period 2003-2005 sixty patients were enrolled in our Unit of Coloproctology. After inoculation hygiene measures (sitz baths, Vaseline oil and water intake) were recommended. After the first 4 weeks without improvement we administered a second injection (30 U.I). After failure of the second administration the patient was addressed to surgery. Mean follow-up was 24 months; patients were re-evaluated at the 6th, 12th and 24th month. RESULTS: In 29 pts the fissure was healed (48.33%) after the first injection; 31 patients (51.6%) were re-treated; 20 pts presented a complete healing of the fissure in a period ranging between 4-5 weeks from the second injection and 11 patients were introduced to surgery. In 3 cases we observed haemorrhoidal thrombosis. Gas incontinence was reported in two patients and solved spontaneously. CONCLUSIONS: Our clinical experience suggests that botulinum toxin therapy can be considered effective and safe. It can be proposed to the patient as first line therapy before surgery.
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Authors | Giuseppe Piccinni, Elisabetta Poli, Anna Angrisano, Andrea Sciusco, Mario Testini |
Journal | Acta bio-medica : Atenei Parmensis
(Acta Biomed)
Vol. 80
Issue 3
Pg. 238-42
( 2009)
ISSN: 0392-4203 [Print] Italy |
PMID | 20578418
(Publication Type: Journal Article)
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Chemical References |
- Neuromuscular Agents
- Botulinum Toxins, Type A
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Anal Canal
(drug effects)
- Botulinum Toxins, Type A
(pharmacology, therapeutic use)
- Chronic Disease
- Female
- Fissure in Ano
(drug therapy)
- Humans
- Male
- Middle Aged
- Neuromuscular Agents
(pharmacology, therapeutic use)
- Pain Measurement
- Prospective Studies
- Therapeutics
- Wound Healing
(drug effects)
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