title: Surgical (close lateral internal sphincterotomy) versus chemical (botulinum toxin) sphincterotomy as treatment of chronic anal fissure.
abstract: 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.
authors.affiliation: Servicio Cirugía General y Aparato Digestivo, Hospital General Universitario de Elche, Elche, Alicante, Spain. arroyocir@hotmail.com
authors.forename: Antonio
authors.initials: A
authors.lastname: Arroyo Sebastián
authors.forename: Francisco
authors.initials: F
authors.lastname: Pérez Vicente
authors.forename: Elena
authors.initials: E
authors.lastname: Miranda Tauler
authors.forename: Ana
authors.initials: A
authors.lastname: Sánchez Romero
authors.forename: Pilar
authors.initials: P
authors.lastname: Serrano Paz
authors.forename: Rafael
authors.initials: R
authors.lastname: Calpena Rico
mesh_terms: 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*
chemical_list: D009465:Neuromuscular Agents; D001905:Botulinum Toxins