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  • Title: The long-term efficacy of fissurectomy and botulinum toxin injection for chronic anal fissure in females.
    Author: Baraza W, Boereboom C, Shorthouse A, Brown S.
    Journal: Dis Colon Rectum; 2008 Feb; 51(2):239-43. PubMed ID: 18175186.
    Abstract:
    INTRODUCTION: Healing rates for botulinum toxin injection for anal fissure may be improved if combined with fissurectomy. This procedure has a decreased risk of incontinence, which is particularly important in females. We investigated the long-term efficacy of fissurectomy and botulinum toxin injection for chronic resistant fissures in females. METHODS: Female patients who consented underwent excision of the fissure edges and injection of 25-100 units of botulinum into the intersphincteric space. Patients were followed up 2 months after the procedure and over a period of up to 39 months. RESULTS: Forty-six patients (mean age, 42 years) were recruited. No patient had incontinence symptoms preoperatively. At a median follow-up period of 11 months, there was a cure rate of 85 percent in 44 patients. After a median follow-up of 22 months, 12 more patients were lost to follow-up. Of the remaining patients, 16 (50 percent) suffered recurrence during the follow-up period. Five patients required further surgical intervention. Three patients suffered chronic perianal infection requiring antibiotic treatment or surgery. There was one case of incontinence at final assessment: the patient complained of urge incontinence, which has persisted for more than 18 months. CONCLUSIONS: Fissurectomy and botulinum toxin injection for the treatment of chronic anal fissure in females seems to be effective in the medium-term but there is a high rate of late recurrence. However, only a minority of patients proceed to more invasive surgical intervention, which may make it a useful option in patients not suitable for lateral sphincterotomy.
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