On-line version ISSN 2078-5151
Print version ISSN 0038-2361
S. Afr. j. surg. vol.48 n.1 Cape Town Feb. 2010
M.D.; Department of General Surgery, Tanta University, Egypt
AIM: Comparison of bilateral versus posterior injection of botulinum toxin into the internal anal sphincter for treatment of acute anal fissure.
METHODS: Forty patients with acute anal fissure were randomly divided into two equal groups. Group 1 was treated by injecting 20 units of botulinum toxin into each side of the internal anal sphincter, and group 2 by injecting 25 units of botulinum toxin into the midline posteriorly.
RESULTS: The mean time to pain relief was 8.45 (standard deviation (SD) 7.41) days in group 1 and 7.20 (SD 7.19) days in group 2. Healing took place in a mean of 5.20 (SD 1.85) weeks in group 1 and 5.40 (SD 2.01) weeks in group 2. Fissures failed to heal in 2 patients in group 1 and 3 in group 2, and recurred in 4 patients in group 1 and 3 in group 2.
CONCLUSION: Botulinum toxin injection is effective in treating acute anal fissure. A single posterior injection is easier and less painful than bilateral injection, and is as effective in pain relief.
“Full text available only in PDF format”
1. Corman M. Anal fissure. In: Corman ML, ed. Colon and Rectal Surgery. 4th ed. Philadelphia: Lippincott-Raven, 1998: 206-223. [ Links ]
2. Oh C, Divino CM, Steinhagen RM. Anal fissure. 20-year experience. Dis Colon Rectum 1995; 38: 378-382. [ Links ]
3. Huskisson EC. Measurement of pain. Lancet 1974; 2: 1127-1131. [ Links ]
4. Jankovic J, Brin MF. Therapeutic uses of botulinum toxin. N Engl J Med 1991; 324: 1186-1194. [ Links ]
5. Madalinski M, Kalinowski L. Novel options for the pharmacological treatment of chronic anal fissure - role of botulin toxin. Curr Clin Pharmacol 2009; 4(1): 47-52. [ Links ]
6. Maria G, Cassetta E, Gui D, Brisinda G, Bentivoglio AR, Albanese A. A comparison of botulinum toxin and saline for the treatment of chronic anal fissure. N Engl J Med 1998; 338: 217-220. [ Links ]
7. Sajid MS, Vijaynagar B, Desai M, Cheek E, Baig MK. Botulinum toxin vs glyceryltrinitrate for the medical management of chronic anal fissure: a meta-analysis. Colorectal Dis 2008; 10(6): 541-546. [ Links ]
8. Maria G, Brisinda G, Bentivoglio AR, Cassetta E, Gui D, Albanese A. Botu-linum toxin injections in the internal anal sphincter for the treatment of chronic anal fissure: long-term results after two different dose regimens. Ann Surg 1998; 228: 664-669. [ Links ]