The long-term efficacy of fissurectomy and botulinum toxin injection for chronic anal fissure in females.

Abstract

INTRODUCTION:

Healing rates for botulinum toxin injection for anal fissure may be improved if combined with fissurectomy. This procedure has a decreased risk of incontinence, which is particularly important in females. We investigated the long-term efficacy of fissurectomy and botulinum toxin injection for chronic resistant fissures in females.

METHODS:

Female patients who consented underwent excision of the fissure edges and injection of 25-100 units of botulinum into the intersphincteric space. Patients were followed up 2 months after the procedure and over a period of up to 39 months.

RESULTS:

Forty-six patients (mean age, 42 years) were recruited. No patient had incontinence symptoms preoperatively. At a median follow-up period of 11 months, there was a cure rate of 85 percent in 44 patients. After a median follow-up of 22 months, 12 more patients were lost to follow-up. Of the remaining patients, 16 (50 percent) suffered recurrence during the follow-up period. Five patients required further surgical intervention. Three patients suffered chronic perianal infection requiring antibiotic treatment or surgery. There was one case of incontinence at final assessment: the patient complained of urge incontinence, which has persisted for more than 18 months.

CONCLUSIONS:

Fissurectomy and botulinum toxin injection for the treatment of chronic anal fissure in females seems to be effective in the medium-term but there is a high rate of late recurrence. However, only a minority of patients proceed to more invasive surgical intervention, which may make it a useful option in patients not suitable for lateral sphincterotomy.

• Authors: Wal Baraza, Catherine Boereboom, Andrew Shorthouse, Steve Brown
• Journal: Diseases of the colon and rectum (Dis Colon Rectum) Vol. 51 Issue 2 Pg. 239-43 (Feb 2008) ISSN: 0012-3706 [Print] United States
• PMID: 18175186 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Neuromuscular Agents
• Botulinum Toxins, Type A

Topics

• Adult
• Aged
• Anal Canal
• Botulinum Toxins, Type A (administration & dosage)
• Chronic Disease
• Digestive System Surgical Procedures (methods)
• Female
• Fissure in Ano (therapy)
• Follow-Up Studies
• Humans
• Injections
• Middle Aged
• Neuromuscular Agents (administration & dosage)
• Retrospective Studies
• Secondary Prevention
• Time Factors
• Treatment Outcome