Fissurectomy and botulinum toxin injection versus fissurectomy and lateral internal sphinctrotomy in treatment of medically resistant chronic anal fissure

Abstract EN

Objectives : Sphinctrotomy is the most widely used treatment for chronic anal fissure which weakens the internal sphincter permanently and may lead to anal deformity and incontinence.

Adding fissurectomy to botulinum toxin injection may improve healing rate of chronic anal fissure than injection of Botulinum toxin alone.

Patients and Methods : this study included 100 consecutive patients with chronic anal fissure, divided into two groups 50 patients each Group (I) underwent Fissurectomy and Botulinum toxin injection, group (II) underwent Fissurectomy and lateral internal sphinctrotomy (LIS) The patients were followed up for an average of 19.8 ± 7.0, and 20.4 ± 6.3 months for group I, and group II, respectively.

Setting : This work was done in the Departments of surgery of the Medical Research Institute and faculty of medicine.

Alexandria University Results : Healing of the fissure was observed in 48 patients (96%) in group I and 46 patients (92%) in group II.

Compared with pre-treatment, post-defecation pain and bleeding had disappeared in all patients.

No complications during the procedure of fissurectomy and (LIS) or fissurectomy and Botulinum-toxin injection such as bleeding.

Seven patients in group I and 8 patients in group II had incontinence of flatus that lasts for three and four weeks for both groups respectively.

The mean resting anal pressure was lower than the baseline value by 42.2%, and 42.4% for group I, and group II, respectively.

The maximum voluntary squeeze pressure was lower than the baseline value by 22.3% and 20.4% for group I and group II, respectively.

Conclusion : Fissurectomy and Botulinum toxin injection is more superior for patients of medically resistant chronic anal fissure than lateral internal sphinctrotomy.

Because it could be repeated when needed without permanent damage to sphincter.

But they are equal as regards pain, anal pressure and healing power.