The Treatment of Chronic Anal Fissure with Botulinum Toxin

Abstract

Background /Aims: The aim of this study was to evaluate the effectiveness of botulinum toxin for the treatment of uncomplicated dorsal chronic idiopathic anal fissure.

Material and Methods: Forty-five patients who reported post defecatory anal pain since two months or more were given a total of 20U botulinum toxin in the anal sphincter apparatus on both sides as well as below the anal fissure. Results: Thirty-seven patients received a second session of 25U botulinum toxin injection. Thirty-five patients (78%) presented completely healed anal fissure, while ten needed lateral internal sphincterotomy. All patients were followed up for 8-36 months. Two patients relapsed.

Conclusion: Local injection of botulinum toxin is a new and safe treatment; however, two sessions of injections are necessary to be effective and long-term follow-up to assess the recurrence rate of fissure is needed to evaluate further this method of treatment. Partial internal lateral sphincterotomy is no more the treatment of choice for chronic anal fissure.

Key Words:

• Chronic anal fissure
• Botulinum toxin
• Sphincterotomy

Additional information

Notes on contributors

E. Pavlakis

E. Pavlakis Petrotou 1 Argithea Paiania GR-Athens, Greece Tel.: [phone] Fax: [phone] E-mail: [email protected]