title: Long-term follow-up after combined fissurectomy and Botox injection for chronic anal fissures.
abstract: OBJECTIVE
  Chronic anal fissures are difficult to treat. The aim of this retrospective study was to determine the outcome of combined fissurectomy and injection of botulinum toxin Type A (BT).
  
  
  METHODS
  Between January 2001 and August 2004, 40 patients (21 women), median age 37 years (range 18 to 57), underwent fissurectomy and BT injection. Fissurectomy was performed followed by injection of 10 U of BT into the internal anal sphincter on both sides of the fissure. All patients were clinically checked 6 weeks after the operation. At 1 year, patients were sent a detailed questionnaire regarding symptoms, recurrence and further treatment for evaluation of long-term results.
  
  
  RESULTS
  At 6 weeks, 38 patients (95%) were free of symptoms. No adverse effects were detected. The response rate of questionnaires was 93%; the median follow-up was 1 year (range 0.9 to 1.6). In the long-term, a recurrence was found in four patients. These patients were treated successfully with repeated fissurectomy and BT injections and salvage procedures, respectively. Overall, the success rate of combined fissurectomy and BT injection was 79%.
  
  
  CONCLUSIONS
  Combined fissurectomy and Botox injection for chronic anal fissure is an excellent and safe procedure with low morbidity and a high healing rate.
authors.affiliation: Department for Visceral and Transplantation Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zurich, Switzerland.
authors.forename: Th
authors.initials: T
authors.lastname: Scholz
authors.forename: F H
authors.initials: FH
authors.lastname: Hetzer
authors.forename: D
authors.initials: D
authors.lastname: Dindo
authors.forename: N
authors.initials: N
authors.lastname: Demartines
authors.forename: P A
authors.initials: PA
authors.lastname: Clavien
authors.forename: D
authors.initials: D
authors.lastname: Hahnloser
mesh_terms: D000293:Adolescent; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A