Yavuz Savaş KOCA, İhsan YILDIZ, Mustafa Tevfik BÜLBÜL

Anal Fissür Tedavisinde Düşük Doz Botulinum Uygulaması ile Yüksek Doz Botulinum Uygulamasının Karşılaştırılması

Amaç: Anal fissür tedavisinde kullanılan Botulinum toksininin kullanım dozlarının komplikasyon ve tedavi etkinliğinin araştırılması. Gereç ve Yöntem: 2011-2013 yılları arasında anal fissürü tedavisi için Botulinum toksini injeksiyonu yapılan toplam 90 hastanın verileri geriye dönük olarak incelendi. Uygulama sonrası hastalar dermografik özellikleri ve erken (ağrı, hematom, infeksiyon, gaz inkontinansı, abse), geç komplikasyonları (gayta inkontinansı, nüks) bakımından incelendi. Bulgular: Tedavide 30 İU Botulinum uygulanan 44 hastadan 34'ünde anal fissürün tamamen iyileştiği görüldü. İyileşme olmayan 10 hastaya 2. kez Botulinum enjeksiyonu yapıldı. Semptomları ve fissürü gerilemeyen 4 hastaya ise aynı tedavi 3. kez tekrarlandı. 4 hastanın sonraki kontrollerinde 1 hastada tamamen iyileşme izlendi. 3 hastada yeterli iyileşme saptanmadı. Bir yıllık kontrolde ise 3 hastada nüks anal fissür tespit edildi. Tedavide 90 İU ile uygulanan 46 hastadan 40'ında anal fissürün tamamen iyileştiği görüldü. İyileşme olmayan 6 hastanın ikisi kendi istekleri üzerine sfinkterotomi operasyonu ile tedavi edilirken diğer 4 hastada yeniden Botulinum enjeksiyonu yapıldı. Bu 4 hastanın sonraki kontrollerinde tamamen iyileşme izlendi. Bir yıllık kontrolde ise 2 hastada nüks anal fissür tespit edildi. Sonuçlar: Botulinum toksini enjeksiyonu düşük komplikasyon ve yaklaşık %90'na varan etkinliği ile güvenli bir şekilde uygulanabilir. Yüksek doz uygulamada geçici komplikasyonlar daha fazla görülmekle birlikte tekrar uygulama gereksinimi düşük doz uygulamaya nazaran anlamlı şekilde düşüktür. Bu da hasta memnuniyeti ve maliyet açısından yüksek doz uygulamayı daha tercih edilebilir bir yöntem kılmaktadır.

Comparison of Low Dose Botulinum Application and High Dose Botulinum Application in Anal Fissure Treatment

Objective: To investigate complications and treatment effectiveness of botulinum toxin doses used in anal fissure treatment. Materials and Methods: A total of 90 patients who underwent botulinum toxin injection for anal fissure treatment between 2011 and 2013 were retrospectively investigated. The demographic characteristics of the patients and early (pain, hematoma, infection, gas incontinence, abscess), late complications (fecal incontinence, recurrence) were investigated after the application. Results: 30 IU Fifty-four patients from 44 patients who were treated with botulinum had anal fissure completely cured. Botulinum injection was performed second time 10 patients who did not heal. The same treatment was repeated 3 times in 4 patients whose symptoms and fissure were not reduced. In the subsequent controls, complete recovery was observed in one but no improvement was observed in 3 patients. In one year control, recurrent anal fissure was observed in 3 patients. In 40 of the 46 patients treated with 90 IU of treatment, the anal fissure was completely healed. Two of the 6 patients who did not heal were treated with sphincterotomy operation on their own wishes, while the other 4 patients received botulinum injection again. Complete recovery was observed in subsequent controls of these 4 patients. In one year control, recurrent anal fissure was observed in 2 patients. Conclusion: Botulinum toxin injection can be safely administered with low complication and up to about 90% efficiency. Although transient complications are more common in high dose administration, the need for repeat administration is significantly lower than in low dose administration, which makes high dose administration a more preferable method in terms of patient satisfaction and cost.

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