Botulinum toxin injection in outpatients for chronic anal fissure

Abstract

Objectives

The aim of the study was to evaluate the effect of botulinum toxin (BT) injection on fissure healing in the treatment of chronic anal fissure (CAF) in outpatient conditions without any analgesia and sedation to the internal anal sphincter (IAS). The primary outcome measure was post-procedural pain. The secondary outcome measures were fissure healing and complications.

Methods

Prospectively preserved data of 67 patients who received BT injections for CAF were analyzed prospectively. Demographic data, duration of symptomatic improvement, fissure location and number, parity, post-procedural pain, complications, continence status, response to treatment, and duration of follow-up were examined. Participants received bilateral (50 + 50 units) BT injections into the internal anal sphincter (IAS) in an outpatient setting.

Results

Symptomatic improvement was observed in 58% of patients within 1 week. The complete response rate to treatment was 82% at a mean follow-up of 6 months. Patients with partial response to treatment (10%) were successfully treated with topical therapy, and patients with persisting fissures (8%) were successfully treated with partial lateral internal sphincterotomy (LIS). 14 patients (21%) reported some degree of transient incontinence at follow-up. Multiparous women experienced more symptoms of Incontinence (p = 0.00). Pre- and post-procedural Vas Score median values were 4. The 7th-week VAS score median value was 3.

Conclusion

Dysport injection under sedation-free outpatient conditions is an effective and safe alternative to LIS for the treatment of CAF, with tolerable procedural pain. All patients should be warned of transient incontinence.

Keywords:

• Botulinum toxin
• chronic anal fissure
• dysport
• incontinence
• sphincterotomy

Author contributions

Design: Dokcu, Başçeken

Data acquisition: Dokcu

Data analysis and interpretation: Dokcu, Başçeken

Drafting the article: Dokcu

Critical revision for intellectual content: Başçeken

Final approval of the manuscript: Dokcu, Başçeken

Patient consent

Preoperative written informed consent for BT injection was obtained from all patients.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data of this study are available in ‘Mendeley Data’ at [https://data.mendeley.com/drafts/4z9m2nmbsf].