Witte ME, Klaase JM, Koop R
Fissurectomy combined with botulinum toxin A injection for medically resistant chronic anal fissures. [JOURNAL ARTICLE]
Colorectal Dis 2009 Oct 13.
ABSTRACT Chemical sphincterotomy, the use of pharmacological agents to reduce anal sphincter resting pressure, has become more and more popular in the treatment of chronic anal fissures (CAFs). It offers the possibility to avoid a lateral internal sphincterotomy and its associated risk of incontinence. In our hospital, patients with a chronic anal fissure are consecutively treated with isosorbide dinitrate 1% ointment, applied 6 times a day for 8 weeks, followed by diltiazem 2% ointment, applied 2 times a day for 8 weeks and Botulin Toxin A injections (Dysport(R)) in the internal anal sphincter. In a previous study (1), we describe high healing rates with this regime. Twenty-one patients (10 males, median age 48 years) with persistent symptoms of chronic anal fissures after following the above mentioned treatment, were enrolled in this study evaluating the effect of the combination of fissurectomy with Botulinum Toxin A (80 U of Dysport(R)) under regional anesthesia in day care. After 12 weeks 19/21 CAFs (90%) had healed. Median follow-up was 16 (9-30) months. No recurrences were seen.
Conclusion: Fissurectomy in combination with Botulinum Toxin A injections in the internal anal sphincter is an effective treatment for medically resistant CAFs.
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