Fissurectomy Combined with High-Dose Botulinum Toxin Is a Safe and Effective Treatment for Chronic Anal Fissure and a Promising Alternative to Surgical Sphincterotomy.

Abstract

BACKGROUND:

There is paucity of data on the long-term outcome of the combination of fissurectomy and botulinum toxin A injection for the management of chronic anal fissure.

OBJECTIVES:

The aim of this study is to assess the safety, efficacy, and long-term outcome of the combination of fissurectomy and botulinum toxin A injection.

DESIGN:

This is a nonrandomized prospective cohort study.

SETTINGS:

This study was conducted at a district general hospital in the United Kingdom.

PATIENTS:

The cohort included all patients treated with fissurectomy and botulinum toxin A for chronic anal fissure between September 2008 and March 2012.

INTERVENTION:

The patients were treated with a combination of fissurectomy and botulinum toxin A injection.

MAIN OUTCOME MEASURES:

Symptomatic relief, fissure healing, complications, recurrence, and the need for further surgical intervention.

RESULTS:

One hundred and two patients received fissurectomy and botulinum toxin A injection for chronic anal fissure. At 12-week follow-up, 68 patients had resolution of symptoms and complete healing of chronic anal fissure, 29 patients had improvement of symptoms but incomplete healing and had further topical or botulinum toxin A treatment with subsequent complete healing. Ninety-five patients (93%) reported no postoperative complications. Seven patients reported a degree of incontinence in the immediate postoperative period. All reported normal continence at12-week follow-up. No local complications were observed or reported. At the mean follow-up of 33 months, there was no evidence of recurrence. Twelve-month follow-up was conducted via telephone interview only.

LIMITATIONS:

This study is nonrandomized and did not examine the dose response of Botulinum Toxin A.

CONCLUSIONS:

Fissurectomy combined with high-dose botulinum toxin A is a safe, effective, and durable option for the management of chronic anal fissure and a promising alternative to surgical sphincterotomy.

• Authors: Thomas G Barnes, Zakhi Zafrani, Ayman S Abdelrazeq
• Journal: Diseases of the colon and rectum (Dis Colon Rectum) Vol. 58 Issue 10 Pg. 967-73 (Oct 2015) ISSN: 1530-0358 [Electronic] United States
• PMID: 26347969 (Publication Type: Journal Article)

Chemical References

• Neuromuscular Agents
• Botulinum Toxins, Type A

Topics

• Adult
• Anal Canal (physiopathology, surgery)
• Botulinum Toxins, Type A (administration & dosage)
• Chronic Disease
• Cohort Studies
• Disease Management
• Dissection (adverse effects, methods)
• Fecal Incontinence (diagnosis, etiology)
• Female
• Fissure in Ano (drug therapy, physiopathology, surgery)
• Humans
• Male
• Neuromuscular Agents (administration & dosage)
• Postoperative Complications (diagnosis)
• Prospective Studies
• Recurrence
• Treatment Outcome
• United Kingdom
• Wound Healing