Comparison of the effectiveness of two treatment modalities for chronic anal fissure: Botox versus sphincterotomy
Coskun Cakir1
, Ufuk Oguz Idiz1, Ibrahim Aydin2, Deniz Firat3, Abdulhakim İbrahim Ulusoy4, Pinar Yazici5
1Istanbul Training And Research Hospital, General Surgery, Istanbul, Turkey
2Avicenna Hospital, General Surgery, Istanbul, Turkey
3Bursa Yuksek Ihtisas Training And Research Hospital, General Surgery, Bursa, Turkey
4Okmeydani Training And Research Hospital, General Surgery, Istanbul, Turkey
5Sisli Hamidiye Etfal Training And Research Hospital, General Surgery, Istanbul, Turkey
Abstract
Objective: Anal fissure is a common health problem that affects the quality of life of young patients. The aim of our study was to benchmark results of lateral internal sphincterotomy (LIS) and botulinum toxin injection in the treatment of chronic anal fissure.
Methods: This multi-center, retrospective study used data from 135 chronic anal fissure patients. Patients' demographic features, clinical findings, fissure characteristics, post-defecation pain score, rectal bleeding or pruritus, and treatment satisfaction scores were recorded. Patients’ data were collected from the hospital records and patients with all of this data available were called and invited to the hospital for examination.
Results: Seventy-four LIS and 61 botulinum toxin applied patients were included. Symptom duration, hospitalization period, and duration of remission of complaints after the treatment were significantly higher in the LIS group (p<0.001). However, pruritus in anus and relapses were found to be higher in the botulinum toxin group (p=¬ 0.04 and p= 0.043, respectively). Abscess and fistula were observed in one patient's perianal region in the LIS group, and an abscess was observed in one patient in the botulinum toxin group. There was no significant difference in treatment satisfaction rates and postoperative complications.
Conclusion: Botulinum toxin yields satisfying results that are comparable to LIS. Patient selection may help mitigate this disease and allow it to be considered a good alternative option to surgery.
Keywords: Chronic anal fissure, Botulinum toxin, Lateral Internal Sphincterotomy, Incontinence
Ethics committee approval was received for this study from Local Human Ethics Committee 2016/631.
Externally peer-reviewed.
Concept - C.Ç., U.O.İ.; Design - İ.A., D.F., P.Y.; Super- vision - C.Ç., U.O.İ., A.İ.U.; Resource - C.Ç., P.Y.; Materials - İ.A., D.F., A.İ.U.; Data Collection and/or Processing - U.O.İ., D.F., P.Y.; Analysis and Interpretation - P.Y., C.Ç., İ.A.; Literature Review - U.O.İ., D.F., İ.A.; Writing Manuscript - C.Ç., İ.A., A.İ.U.; Critical Reviews - U.O.İ., P.Y.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.