Fissurectomy Combined with High-Dose Botulinum Toxin Is a Safe and Effective Treatment for Chronic Anal Fissure and a Promising Alternative to Surgical Sphincterotomy.
BACKGROUND
There is paucity of data on the long-term outcome of the combination of fissurectomy and botulinum toxin A injection for the management of chronic anal fissure.


OBJECTIVE
The aim of this study is to assess the safety, efficacy, and long-term outcome of the combination of fissurectomy and botulinum toxin A injection.


METHODS
This is a nonrandomized prospective cohort study.


METHODS
This study was conducted at a district general hospital in the United Kingdom.


METHODS
The cohort included all patients treated with fissurectomy and botulinum toxin A for chronic anal fissure between September 2008 and March 2012.


METHODS
The patients were treated with a combination of fissurectomy and botulinum toxin A injection.


METHODS
Symptomatic relief, fissure healing, complications, recurrence, and the need for further surgical intervention.


RESULTS
One hundred and two patients received fissurectomy and botulinum toxin A injection for chronic anal fissure. At 12-week follow-up, 68 patients had resolution of symptoms and complete healing of chronic anal fissure, 29 patients had improvement of symptoms but incomplete healing and had further topical or botulinum toxin A treatment with subsequent complete healing. Ninety-five patients (93%) reported no postoperative complications. Seven patients reported a degree of incontinence in the immediate postoperative period. All reported normal continence at12-week follow-up. No local complications were observed or reported. At the mean follow-up of 33 months, there was no evidence of recurrence. Twelve-month follow-up was conducted via telephone interview only.


CONCLUSIONS
This study is nonrandomized and did not examine the dose response of Botulinum Toxin A.


CONCLUSIONS
Fissurectomy combined with high-dose botulinum toxin A is a safe, effective, and durable option for the management of chronic anal fissure and a promising alternative to surgical sphincterotomy.
Warrington Hospital, Warrington, Merseyside, United Kingdom.
Thomas G
TG
Barnes
Zakhi
Z
Zafrani
Ayman S
AS
Abdelrazeq
D000328:Adult; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002908:Chronic Disease; D015331:Cohort Studies; D019468:Disease Management; D004210:Dissection / Q000009:adverse effects / Q000379:methods; D005242:Fecal Incontinence / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage; D011183:Postoperative Complications / Q000175:diagnosis*; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D006113:United Kingdom; D014945:Wound Healing
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A