[Favourable results with local injections of botulinum-A toxin in patients with chronic isosorbide dinitrate ointment-resistant anal fissures].
OBJECTIVE
To determine the effectiveness of injection of botulinum-A toxin in the internal anal sphincter as a treatment for chronic therapy-resistant anal fissures.


METHODS
Prospective.


METHODS
In the period October 2002-February 2005, 32 consecutive patients (15 men and 17 women), with a median age of 44 years (range: 23-78 years) and suffering from chronic isosorbide dinitrate ointment-resistant anal fissures, were treated with an injection of 40 IU botulinum-A toxin (Dysport, Ipsen, The Netherlands) in the ventral side of the internal anal sphincter. The injection was given as an outpatient procedure under general or spinal anaesthesia.


RESULTS
After a median follow-up of 14 months (range: 2-28 months), the chronic anal fissures were cured in 24 ofthe 32 patients (75%). Twenty-two patients were given a second or a third injection. A fissure recurred in one of the cured patients (4%), and one patient suffered from temporary flatus incontinence.


CONCLUSIONS
Botulinum-A toxin injections were effective in 75% of patients with isosorbide dinitrate ointment-resistant chronic anal fissures. This is a simple technique with fewer side effects than local application of NO donors and fewer complications and less morbidity than surgical sphincterotomy.
Witte
M E
ME
Medisch Spectrum Twente, Afd. Chirurgie, Haaksbergerstraat 55, 7500 KA Enschede.
Klaase
J M
JM
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000187:drug effects* / Q000601:surgery; D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy*; D006801:Humans; D007548:Isosorbide Dinitrate / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D020030:Nitric Oxide Donors / Q000627:therapeutic use; D011446:Prospective Studies; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D020030:Nitric Oxide Donors; D019274:Botulinum Toxins, Type A; D007548:Isosorbide Dinitrate