title: Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials.
abstract: BACKGROUND
  Although surgery is the gold standard treatment for anal fissure, the main concern remains its side effects and complications. Botulinum toxin injection and lateral internal sphincterotomy are technical options for patients suffering from chronic anal fissure. However, little is known about the efficacy of these two techniques. The aim of this meta-analysis was to compare the outcomes of botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure.
  
  
  METHODS
  Original studies in English were searched from the MEDLINE database, PubMed, Web of Science, and the Cochrane Library database. Randomized control trials that compared botulinum toxin injection with lateral internal sphincterotomy were identified. Data were independently extracted for each study, and a meta-analysis was performed using fixed and random effects models.
  
  
  RESULTS
  Four hundred and eighty-nine patients from seven trials met the inclusion criteria. Patients undergoing lateral internal sphincterotomy had a higher-healing and incontinence rate. No statistically significant differences were noted in total complications between botulinum toxin injection and lateral internal sphincterotomy. Patients treated with lateral internal sphincterotomy had a significantly lower recurrence rate than the patients treated with botulinum toxin injection.
  
  
  CONCLUSIONS
  Our meta-analysis shows that lateral internal sphincterotomy was superior to botulinum toxin injection in terms of healing rate and lower recurrence rate. Botox, however, is safe associated with a lower rate of incontinence and could be used in certain situations. Further studies with a long-term follow-up are required to confirm our observations.
authors: Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, No. 26 Yuancun Er Heng Rd, Tianhe District, Guangzhou, 510655, Guangdong Province, People's Republic of China.
authors: H-L
authors: HL
authors: Chen
authors: X-B
authors: XB
authors: Woo
authors: H-S
authors: HS
authors: Wang
authors: Y-J
authors: YJ
authors: Lin
authors: H-X
authors: HX
authors: Luo
authors: Y-H
authors: YH
authors: Chen
authors: C-Q
authors: CQ
authors: Chen
authors: J-S
authors: JS
authors: Peng
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage; D001003:Anal Canal / Q000601:surgery*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002908:Chronic Disease; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005401:Fissure in Ano / Q000628:therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A