Botox for chronic anal fissure: is it useful? A clinical experience with mid-term follow-up.
BACKGROUND
Sphincterotomy has been the most commonly used treatment for chronic anal fissures. Although effective it is associated with incontinence (0-20%). Intrasphincteric Botulinum Toxin A injection seems to be a reliable option. The aim of this clinical report is to verify the effectiveness of this treatment in relieving symptoms and healing fissures without relapse.


METHODS
The study design was an open label non-comparative prospective trial to evaluate the efficacy ofbotulinum toxin injection in anal sphincters. In the period 2003-2005 sixty patients were enrolled in our Unit of Coloproctology. After inoculation hygiene measures (sitz baths, Vaseline oil and water intake) were recommended. After the first 4 weeks without improvement we administered a second injection (30 U.I). After failure of the second administration the patient was addressed to surgery. Mean follow-up was 24 months; patients were re-evaluated at the 6th, 12th and 24th month.


RESULTS
In 29 pts the fissure was healed (48.33%) after the first injection; 31 patients (51.6%) were re-treated; 20 pts presented a complete healing of the fissure in a period ranging between 4-5 weeks from the second injection and 11 patients were introduced to surgery. In 3 cases we observed haemorrhoidal thrombosis. Gas incontinence was reported in two patients and solved spontaneously.


CONCLUSIONS
Our clinical experience suggests that botulinum toxin therapy can be considered effective and safe. It can be proposed to the patient as first line therapy before surgery.
Piccinni
Giuseppe
G
Department of Application in Surgery of Innovative Technologies (D.A.C.T.I.), Unit of General Surgery, University of Bari, Italy. beppestras@yahoo.it
Poli
Elisabetta
E
Angrisano
Anna
A
Sciusco
Andrea
A
Testini
Mario
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000187:drug effects; D019274:Botulinum Toxins, Type A / Q000494:pharmacology / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D010147:Pain Measurement; D011446:Prospective Studies; D013812:Therapeutics; D014945:Wound Healing / Q000187:drug effects
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A