The international surgical journal with global reach

This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Botulinum toxin for recurrent anal fissure following lateral internal sphincterotomy. BJS 2008; 95: 774-778.

Published: 18th April 2008

Authors: G. Brisinda, F. Cadeddu, F. Brandara, G. Marniga, S. Vanella, C. Nigro et al.

Background

The aim of the study was to evaluate the efficacy of botulinum toxin injection in the treatment of recurrent anal fissure following lateral internal sphincterotomy.

Method

Eighty patients were treated with botulinum toxin (30 units Botox® or 90 units Dysport®), injected into two sites of the internal sphincter. Clinical and manometric results were recorded before and after treatment. If symptoms persisted at 2 months, the examiners could decide to re‐treat the patient. The same preparation of serotype A of botulinum neurotoxin was used for reinjection.

Results

One month after injection there was complete healing in 54 patients (68 per cent). Eight patients (10 per cent) reported mild incontinence of flatus that had disappeared spontaneously within 2 months. At 2 months, 59 patients (74 per cent) had a healing scar. After reinjection, 11 of 21 re‐treated patients reported mild incontinence to flatus that lasted for a few weeks and resolved spontaneously. Anorectal manometry at 1 month demonstrated a significant reduction in both resting anal pressure and maximum voluntary squeeze pressure (P < 0·001). There were no relapses during a mean value of 57·9 months of follow‐up.

Conclusion

Botulinum toxin is efficacious in patients with recurrent anal fissure following lateral internal sphincterotomy. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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