Long-term follow-up (42 months) of chronic anal fissure after healing with botulinum toxin.
OBJECTIVE
Botulinum toxin is an effective treatment in idiopathic chronic anal fissure, but the long-term outcome after healing is not well documented. We analyzed the long-term outcome of patients in whom an anal fissure had healed after botulinum toxin injection and the factors contributing to recurrence.


METHODS
Fifty-seven patients who had completely healed 6 months after injection of botulinum toxin were reassessed every 6 months. The follow-up was 42 months in all patients. Clinical and manometric differences between the permanently healed and the relapsed group were statistically analyzed.


RESULTS
Four patients were lost to follow-up. A fissure recurrence was shown in 22 patients (41.5%). Statistical differences between the permanently healed and the relapsed group were detected when analyzing the anterior location of the fissure (6% vs. 45%), a longer duration of the disease (38% vs. 68%), the need for reinjection (26% vs. 59%), a higher total dose injected to achieve definitive healing (13% vs. 45%), and the percentage decrease of maximum squeeze pressure after injection (-28% vs. -13%; P < 0.05).


CONCLUSIONS
The late recurrence rate of chronic anal fissure is high when the effect of botulinum toxin disappears. The highest risk of recurrence is associated with anterior location of the anal fissure, prolonged illness, the need for reinjection and for high doses to achieve healing, and a lower decrease of maximum squeeze pressure after treatment.
Minguez
Miguel
M
Department of Gastroenterology, Clinic Hospital, University of Valencia, Valencia, Spain. mminguezp@meditex.es
Herreros
Belen
B
Espi
Alejandro
A
Garcia-Granero
Eduardo
E
Sanchiz
Vicente
V
Mora
Francisco
F
Lledo
Salvador
S
Benages
Adolfo
A
D000328:Adult; D000368:Aged; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy* / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D011312:Pressure; D012008:Recurrence; D019233:Retreatment; D014945:Wound Healing / Q000187:drug effects
D001905:Botulinum Toxins