[Manometric factors associated with recurrence in botulinum toxin treatment for chronic anal fissure].
OBJECTIVE
To evaluate the effectiveness of botulinum toxin in the treatment of chronic anal fissure after long-term follow-up and establish the manometric factors related to recurrence.


METHODS
We performed a prospective study in 50 consecutive patients with chronic anal fissure who were treated with 25 U botulinum toxin injected into the internal sphincter. Clinical and manometric parameters were recorded until the fourth year of follow-up.


RESULTS
There was a tendency to progressive recurrence over time (54% at 4 years) associated with manometric factors indicating hyperexcitability of the internal anal sphincter (persistently elevated mean resting pressure, percentage of time with slow waves, and number of patients or percentage of time with ultra-slow waves after treatment).


CONCLUSIONS
Treatment of chronic anal fissure with botulinum toxin leads to long-term cure in less than 50% of patients. In patients with manometric factors related to recurrence, this treatment is insufficient for definitive cure.
Arroyo
A
A
Unidad de Coloproctología, Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario de Elche, Elche, Alicante, España. arroyocir@hotmail.com
Pérez-Vicente
F
F
Miranda
E
E
Serrano
P
P
Pérez-Vázquez
Mt
M
Calpena
R
R
D000328:Adult; D001003:Anal Canal / Q000503:physiopathology*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy* / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects*; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence; D013997:Time Factors
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A