Is injection of botulinum toxin a treatment of choice for chronic anal fissure?

To evaluate the effectiveness of injection of botulinum toxin as first line treatment for idiopathic chronic anal fissure. Descriptive case series. Private clinics from January 2010 - December 2011. Twenty-nine patients with posterior midline chronic anal fissure, with the age ranging from 25-60 year, were inducted in this study. They did not suffer from any other anal or systemic disease. Twenty units of botulinum toxin was diluted in 1ml of normal saline. An insulin syringe of 25G needle was used for injection keeping patients in left lateral position. Anal canal was sprayed for 30 second with 10% xylocaine spray. The filled toxin was injected into the two sides of the fissure and at its base. Patients were examined after one week and then every 2 weeks till the fissure heal [maximum duration 12 weeks]. They were also asked to keep record of pain during defecation and bleeding per rectum. Pain during defecation disappeared by the third day in all the patients. Bleeding per rectum stopped by first week in 14 [48.2%] patients and by third week in others. By 10th week, 25 [86.2%] patients had their fissure healed. The remaining did not heal till 12[th] weeks. A healing rate of 86.2% within 10 weeks was achieved which is much better than other nonoperative modalities.

Leakage of colorectal anastomosis: experience at Civil Hospital, Karachi

To determine the frequency and outcome of leakage of Colorectal anastomosis. A descriptive study from Jan. 1997 to Dec. 2003. Surgical Unit I and V of Civil Hospital, Karachi. One hundred and sixty four patients admitted with colorectal cancer, colon or rectal injury and those admitted for restorative procedures were included in the study. Detailed history, physical examination and relevant investigation were carried out. Patients were operated by a senior surgeon. Patients were closely monitored after surgery for clinical signs of anastomotic leakage. CT scan was performed on the 10th postoperative day to ascertain the integrity of the anastomosis. Colonic anastomosis was done in 118 cases with an anastomotic leak of 3.4%, while rectal anastomosis was done in 28 patients with an anastomotic leak of 17.8% and a mortality of 10.7%. In most patients the average hospital stay after operation was 14 days. The overall anastomotic leak was 6.09% and mortality 2.4%. Colorectal anastomotic leakage is a serious complication. A high index of suspicion is required. Early diagnosis and prompt treatment are crucial in obtaining optimal results