Botox for chronic anal fissure: is it useful? A clinical experience with mid-term follow-up.

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.

• 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)

Chemical References

• Neuromuscular Agents
• Botulinum Toxins, Type A

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)