GENERAL SURGERY

Bilateral versus posterior injection of botulinum toxin in the internal anal sphincter for the treatment of acute anal fissure

Ibrahim Othman

M.D.; Department of General Surgery, Tanta University, Egypt

ABSTRACT

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.

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REFERENCES

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 ]