Botulinum toxin versus surgical sphincterotomy in females with chronic anal fissure

ABSTRACT

To compare the effectiveness and the morbidity of botulinum toxin [BTX] in the treatment of chronic anal fissure [CAF] versus the standard surgical sphincterotomy. One hundred female patients with CAF were treated by either closed lateral sphincterotomy [surgical group [Group I, n=50 patients]] or BTX 40 IU [chemical group [Group II, n=50 patients]]. The study was conducted in the King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, over 3 years between January 2004 and December 2006. The healing rate was 100% in surgical group with no recurrence on the period of 3 years follow up and one patient has partial permanent incontinence. While in chemical group the healing rate was 86% [p=0.006]. Ten patients had transient incontinence [p=0.014]. Seven patients had recurrence within 6 months 14% [p=0.006]. We conclude that chemical sphincterotomy is safe, effective first line treatment in selected female patients with CAF