Surgical (close lateral internal sphincterotomy) versus chemical (botulinum toxin) sphincterotomy as treatment of chronic anal fissure.
OBJECTIVE
The aim of this prospective randomized trial was to compare the effectiveness and morbidity of surgical vs chemical sphincterotomy in the treatment of chronic anal fissure after a 3-year follow-up period.


METHODS
Eighty patients with chronic anal fissure were treated either with close lateral internal sphincterotomy (group 1) or with chemical sphincterotomy with 25 U botulinum toxin injected into the internal sphincter (group 2).


RESULTS
Overall healing was 90% in the close sphincterotomy group and 45% in the toxin botulinum group (p < 0.001). There was a group of patients with clinical factors (duration of disease over 12 months and presence of a sentinel pile before treatment) associated with a higher recurrence of anal fissure. Final percentage of incontinence was 5% in the close sphincterotomy group and 0% in the botulinum toxin group (p > 0.05). All incontinent patients were aged more than 50 years.


CONCLUSIONS
We recommend surgical sphincterotomy as the first therapeutic approach in patients with clinical factors of recurrence. However, we recommend the use of botulinum toxin in patients older than 50 years or with associated risk factors of incontinence, despite the higher rate of recurrence, since it avoids the greater risk of incontinence seen with surgery.
Arroyo Sebastián
Antonio
A
Servicio Cirugía General y Aparato Digestivo, Hospital General Universitario de Elche, Elche, Alicante, Spain. arroyocir@hotmail.com
Pérez Vicente
Francisco
F
Miranda Tauler
Elena
E
Sánchez Romero
Ana
A
Serrano Paz
Pilar
P
Calpena Rico
Rafael
R
D000328:Adult; D001905:Botulinum Toxins / Q000627:therapeutic use*; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005401:Fissure in Ano / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic / Q000379:methods*
D009465:Neuromuscular Agents; D001905:Botulinum Toxins