Abstract
BackgroundAlthough lateral internal sphincterotomy is the gold-standard treatment for chronic anal fissure, intrasphincteric injection of botulinum toxin seems to be a reliable new option. The aim of this non-randomized study is to compare the effect of lateral internal sphincterotomy and botulinum toxin injection treatments on the outcome and reduction of anal sphincter pressures in patients with chronic anal fissure.MethodsPatients with chronic anal fissure were treated with either botulinum toxin injection or lateral internal sphincterotomy by their own choice. Maximal resting pressure and maximal squeeze pressure measurements were performed before and 2 weeks after treatments by anal manometry. Patients were followed for fissure relapse during 14 months.ResultsTwenty-one consecutive outpatients with posterior chronic anal fissure were enrolled. Eleven patients underwent surgery and ten patients received botulinum toxin injection treatment. Before the treatment, anal pressures were found to be similar in both groups. After the treatment, the maximal resting pressures were reduced from 104 ± 22 mmHg to 86 ± 15 mmHg in the surgery group (p < 0.05) and from 101 ± 23 mmHg to 83 ± 24 mmHg in the botulinum toxin group (p < 0.05). The mean maximal squeeze pressures were reduced from 70 ± 27 mmHg to 61 ± 32 mmHg (p > 0.05) in the surgery group, and from 117 ± 62 mmHg to 76 ± 34 (p < 0.01) in the botulinum toxin group. The fissures were healed in 70 percent of patients in the botulinum group and 82 percent in the surgery group (p > 0.05). There were no relapses during the 14 months of follow up.ConclusionLateral internal sphincterotomy and botulinum toxin injection treatments both seem to be equally effective in the treatment of chronic anal fissure.
Highlights
Lateral internal sphincterotomy is the gold-standard treatment for chronic anal fissure, intrasphincteric injection of botulinum toxin seems to be a reliable new option
MSP was defined as the mean of differences between the mean pressures obtained by voluntary squeezing for 5 seconds and resting pressures when all of the holes were within the anal canal
The MRP was reduced to 86 ± 15 mmHg in the Lateral internal sphincterotomy (LIS) (p < 0.05) and to 83 ± 24 mmHg in the botulinum toxin (BT) group (p < 0.05)
Summary
Patients Consecutive adults with symptomatic CAF were enrolled into the study. The diagnosis of CAF was based on the following criteria: evidence of posterior circumscribed ulcer, with a large sentinel tag of skin, induration at the edges, and exposure of the horizontal fibers of the internal anal sphincter (IAS); symptoms (post-defecatory or nocturnal pain, bleeding, or both) lasting for more than two months. All the patients underwent a pre-treatment evaluation which included clinical inspection of the fissure and anorectal manometry. Anal manometry Anal sphincter manometry was performed on the CAF patients before and at the 3rd week of the treatment. MSP was defined as the mean of differences between the mean pressures obtained by voluntary squeezing for 5 seconds and resting pressures when all of the holes were within the anal canal. The primary end points of the study were complete healing of the CAF and complications after treatment. The patients with healed fissures were followed clinically for at least 12 months. In the follow up period, patients were re-examined by inspection and re-evaluated for symptoms at 6th and 12th months (evaluation for fissure relapse). Probability values of less than 0.05 were considered significant
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