Comparing Botulinum Toxin Versus Lord’s Procedure in Patients with Chronic Anal Fissure: A Prospective Study

ABSTRACT

Introduction: Anal fissure (AF) is a common disease. It causes considerable discomfort, loss of working days, and reduction in quality of life. Symptoms of AF include anal pain during defecation and bleeding per anus. Acute AF is treated conservatively, but chronic AF (CAF) does not usually respond to conservative treatment. Anal stretch (Lord’s procedure), reintroduced into AF therapy in 1964 with significant success rates, is, however, associated with recurrence rates varying from 2% to 80%, a high risk of incontinence (up to 51%), and is widely criticized despite a reported cure rate of approximately 90%. Materials and Methods: The present prospective study was conducted after due approval of “Scientific and Ethical Committee” in the Department of General Surgery of Mata Chanan Devi Hospital, New Delhi, during the period from October 2013 to May 2015 on patients attending the outpatient department or emergency department of this hospital. Results: In the present study, all 50 patients were selected and randomized into two treatment groups. Results were compared among two groups Group B Patients receiving Botulinum toxin-A (BOTOX) injection (n1 = 25) and Study Groups Group1=Group-B ,Group-2=Group-D. Randomisation Will Be As Follows. Group-B (Botox) Vs Group-D(Lords Procedure) Patients who underwent Lord’s procedure (n2 = 25). All results are well tabulated and described in figure format for well understanding in main article. Conclusion: BOTOX is as good as an option, compared to ancient yet routinely practiced LORD’S anal dilatation technique for CAF. BOTOX significantly reduces pain in patients with CAF as compared to Lord’s procedure. BOTOX has definite action in reducing the spasm of internal anal sphincter which is the chief cause of development of CAF. Spasm significantly improves with BOTOX compared to Lord’s procedure.