title: Botulinum toxin for chronic anal fissure after biliopancreatic diversion for morbid obesity.
abstract: OBJECTIVE
  To study the effect of botulinum toxin in patients with chronic anal fissure after biliopancreatic diversion (BPD) for severe obesity.
  
  
  METHODS
  Fifty-nine symptomatic adults with chronic anal fissure developed after BPD were enrolled in an open label study. The outcome was evaluated clinically and by comparing the pressure of the anal sphincters before and after treatment. All data were analyzed in univariate and multivariate analysis.
  
  
  RESULTS
  Two months after treatment, 65.4% of the patients had a healing scar. Only one patient had mild incontinence to flatus that lasted 3 wk after treatment, but this disappeared spontaneously. In the multivariate analysis of the data, two registered months after the treatment, sex (P = 0.01), baseline resting anal pressure (P = 0.02) and resting anal pressure 2 mo after treatment (P < 0.0001) were significantly related to healing rate.
  
  
  CONCLUSIONS
  Botulinum toxin, despite worse results than in non-obese individuals, appears the best alternative to surgery for this group of patients with a high risk of incontinence.
authors.affiliation: Department of Surgery, Catholic School of Medicine, University Hospital Agostino Gemelli, 00168 Rome, Italy.
authors.forename: Serafino
authors.initials: S
authors.lastname: Vanella
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Brisinda
authors.forename: Gaia
authors.initials: G
authors.lastname: Marniga
authors.forename: Anna
authors.initials: A
authors.lastname: Crocco
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bianco
authors.forename: Giorgio
authors.initials: G
authors.lastname: Maria
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion / Q000009:adverse effects*; D001905:Botulinum Toxins / Q000627:therapeutic use*; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D001905:Botulinum Toxins