High-dose botulinum toxin in chronic anal fissure treatment: Short term results

Abstract

Aim: Botulinum toxin (BT) injection into the internal anal sphincter is gaining popularity as a second line therapy for chronic anal fissures if medical therapy fails. There is no consensus on BT dosing to be used in chronic anal fissure (CAF) treatment. The aim of our study is to research the complication of high-dose BT in CAF treatment and its treatment effectiveness. Material and Methods: The data of 19 patients who underwent BT injection for CAF treatment between the years of 2014 and 2018 were analyzed retrospectively. Demographic characteristics of the patients, complications observed due to BT injection, healing and recurrence cases were recorded. Results: Nineteen patients who underwent 90 IU BT treatment followed for an average of 9.4 (min 3- max 46) months, It was observed that anal fissure was completely healed in 16 (84.2%) but no improvement was observed in 3 (15.8%). One of the recovered 16 patients was found to have recurrent anal fissure on the 5th month. In the patients who had BT, it was observed that 2 of the patients (%10.5) had abdominal pain in the first day requiring analgesic use, 2 of the patients (%10.5) had abdominal bloating (gas) which healed itself spontaneously within approximately one week, 2 (%10.5) of the patients had redness on the injection area on the first day and 3 (%15.8) of the patients had gas incontinence which healed itself spontaneously within approximately 2 weeks. Conclusion: High-dose BT injection can be safely performed with low complication, high recovery rate and low recurrence rate. Prospective studies in larger series of patients are needed to obtain clearer results.