High-dose versus low-dose botulinum toxin in anal fissure disease.

Abstract

BACKGROUND:

There is no consensus on the optimal dosage of botulinum toxin (BT) as a sphincter sparing alternative to lateral internal sphincterotomy for chronic anal fissure. The aim of this study was to assess the long-term efficacy of high-dose BT as well as the presence of incontinence following the treatment of chronic anal fissure at a single institution.

METHODS:

A retrospective case-control study was performed at a single institution over a 6-year period (2009-2014). Patients given high-dose (80-100 IU) BT were compared to low-dose (20-40 IU) case controls. Clinical notes were reviewed, and follow-up was carried out via a telephone questionnaire.

RESULTS:

One hundred and fifty-eight patients were treated with BT injections within the study period (103 high dose; 55 low dose). The mean length of follow-up was 25 months (range 4-52 months). Classic posterior fissures with high anal tone were more prevalent in the low-dose group (40 vs 47%, p = 0.3). Patient satisfaction was higher in the high-dose group (90 vs 78%, p = 0.05). Long-term recurrence (6 months after the last treatment) was also lower (23 vs 53%, p = 0.0001) on multivariate analysis. No long-term incontinence was observed.

CONCLUSIONS:

In this series, the recurrence rate post-BT injection was significantly lower in the high-dose group. There was no long-term incontinence. Further studies are needed to confirm our results.

• Authors: P Ravindran, D L Chan, C Ciampa, R George, G Punch, S I White
• Journal: Techniques in coloproctology (Tech Coloproctol) Vol. 21 Issue 10 Pg. 803-808 (Oct 2017) ISSN: 1128-045X [Electronic] Italy
• PMID: 29080958 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Acetylcholine Release Inhibitors
• Botulinum Toxins

Topics

• Acetylcholine Release Inhibitors (administration & dosage, adverse effects)
• Adult
• Aged
• Botulinum Toxins (administration & dosage, adverse effects)
• Case-Control Studies
• Chronic Disease
• Fecal Incontinence (etiology)
• Female
• Fissure in Ano (drug therapy)
• Humans
• Male
• Middle Aged
• Patient Satisfaction
• Recurrence
• Retrospective Studies
• Time Factors