High-dose botulinum toxin in chronic anal fissure treatment: Short term results

High-dose botulinum toxin in chronic anal fissure treatment: Short term results

Aim: Botulinum toxin (BT) injection into the internal anal sphincter is gaining popularity as a second line therapy for chronic anal fissures if medical therapy fails. There is no consensus on BT dosing to be used in chronic anal fissure (CAF) treatment. The aim of our study is to research the complication of high-dose BT in CAF treatment and its treatment effectiveness.Material and Methods: The data of 19 patients who underwent BT injection for CAF treatment between the years of 2014 and 2018 were analyzed retrospectively. Demographic characteristics of the patients, complications observed due to BT injection, healing and recurrence cases were recorded.Results: Nineteen patients who underwent 90 IU BT treatment followed for an average of 9.4 (min 3- max 46) months, It was observed that anal fissure was completely healed in 16 (84.2%) but no improvement was observed in 3 (15.8%). One of the recovered 16 patients was found to have recurrent anal fissure on the 5th month. In the patients who had BT, it was observed that 2 of the patients (%10.5) had abdominal pain in the first day requiring analgesic use, 2 of the patients (%10.5) had abdominal bloating (gas) which healed itself spontaneously within approximately one week, 2 (%10.5) of the patients had redness on the injection area on the first day and 3 (%15.8) of the patients had gas incontinence which healed itself spontaneously within approximately 2 weeks.Conclusion: High-dose BT injection can be safely performed with low complication, high recovery rate and low recurrence rate. Prospective studies in larger series of patients are needed to obtain clearer results.

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  • 1. Nelson RL. Anal fi ssure (chronic). BMJ Clin Evid 2014;12:2014.
  • 2. Brown AC, Sumfest JM, Roswadowski JV. Histopathology of the internal sphincter in chronic anal fissure. Dis Colon Rectum 1989;32:680-3.
  • 3. Bobkiewicz A, Francuzik W, Krokowicz L, et al. Botulinum toxin injection for treatment of chronic anal fissure: is there any dose-dependent efficiency? a meta-analysis. World J Surg 2016;40:3063.
  • 4. Shao WJ, Li GC, Zhang ZK. Systematic review and meta-analysis of randomized controlled trials comparing botulinum toxin injection with lateral internal sphincterotomy for chronic anal fissure. Int J Colorectal Dis 2009;24:995-1000.
  • 5. Hazar H. Anal fissure and high dose botulinum toxin:a pilot study of 11 patients. Turk J Colorectal Dis 2013;23:24-30.
  • 6. Collins EE, Lund JN. A review of chronic anal fissure management. Tech. Coloproctol 2007;11:209-23.
  • 7. Medhi B, Rao RS, Prakash A, et al. Recent advances in the pharmacotherapy of chronic anal fissure: An update. Asian J. Surg 2008;31:154-63.
  • 8. Nelson R. A systematic review of medical therapy for anal fissure. Dis Colon Rectum 2004;47:422-31.
  • 9. Whatley JZ, Tang SJ, Glover PH, et al. Management of complicated chronic anal fissures with high-dose circumferential chemodenervation (HDCC) of the internal anal sphincter. Int J Surg 2015;24:24-6.
  • 10. Halahakoon VC, Pitt JP. Anal advancement flap and botulinum toxin A (BT) for chronic anal fissure (CAF). Int J Colorectal Dis 2014;29:1175-7.
  • 11. 11. Higuero T. Update on the management of the anal fissure. J Visc Surg 2015;152:37-43.
  • 12. Fleshman JW. Anorectal motor physiology and pathophysiology. Surg Clin North Am 1993;73:1245-65.
  • 13. Mason PF, Watkins MJ, Hall HS, et al. The management of chronic fissure in ano with botulinum toxin. J R Coll Surg Edinb 1996;41:235-8.
  • 14. Oh C, Divino CM, Steinhagen RM. Anal fissure: 20-year experience. Dis Colon Rectum 1995;38:378-82.
  • 15. Arroyo A, Perez F, Serrano P. et al. Open versus closed lateral sphincterotomy performed as an outpatient procedure under local anesthesia for chronic anal fissure: Prospective randomized study of clinical and manometric longterm results 1. J Am Coll Surg 2004;199:361-7.
  • 16. Hymann N. Incontinence after lateral internal sphincterotomy: a prospective study and quality of life assessment. Dis Colon Rectum 2004;47:35-8.
  • 17. Brin MF. Botulinum toxin: chemistry, pharmacology, toxicity, and immunology. Muscle Nerve Suppl 1997;6:146-68.
  • 18. Cumaoglu A, Karasu C. Pharmacological aspects and therapeutic perspective. Turkiye Kinikleri J Int Med Sci 2007;3:1-6.
  • 19. Jankovic J, Brin M. Therapeutic uses of botulinum toxin. N Engl J Med 1991;324:1186-94.
  • 20. McDonald A, Smith A, McNeil AD, et al. Finlay IG. Manual dilatation of the anus. Br J Surg 1992;79:1381-2
  • 21. Yiannakopoulou E. Botulinum toxin and anal fi ssure: effi cacy and safety systematic review. Int J Colorectal Dis 2012;27:1-9.
  • 22. Maria G, Brisinda G, Bentivoglio AR, et al. Botulinum toxin injections in the internal anal sphincter for the treatment of chronic anal fissure: Long-term results after two different dosage regimens. Ann surg 1998;228:664-9.
  • 23. Tawfiq JM Al-Marzooq. Effectiveness of botox in treating chronic anal fissure: a clinical experience with mid-term follow up. Int J Med Res Health Sci 2017;6:101-6.
  • 24. Madalinski MH, Slawek J, Zbytek B, et al. Topical nitrates and the higher doses of botulinum toxin for chronic anal fissure. Hepatogastroenterology 2001;48:977-9.
  • 25. Maria G, Cassetta E, Gui D, et al. A comparison of botulinum toxin and saline for the treatment of chronic anal fissure. New Eng J Med 1998;338:217-20.
  • 26. Jost, WH. One hundred cases of anal fissure treated with botulinum toxin. Early and long-term results. Dis Colon Rectum 1997;40:1029-32.
  • 27. Arroyo A, Pérez F, Serrano P, et al. Surgical versus chemical (botulinum toxin) sphincterotomy for chronic anal fissure: long-term results of a prospective randomized clinical and manometric study. Am J Surg 2005;189:429-34.
  • 28. Wald A, Bharucha AE, Cosman BC, et al. ACG clinical guideline: Management of benign anorectal disorders. Am J Gastroenterol 2014;109:1141-57.
  • 29. Sinha R, Kaiser AM. Efficacy of management algorithm for reducing need for sphincterotomy in chronic anal fissures. Colorectal Dis 2012;14:760-4.
Annals of Medical Research-Cover
  • Yayın Aralığı: Aylık
  • Yayıncı: İnönü Üniversitesi Tıp Fakültesi
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