Treatment Of Chronic Anal Fissure; Lateral Internal Sphincterotomy Versus Local Injection Of High Dose Botulinum Toxin. A Randomized Clinical Trial.

[摘要] Chronic anal fissure (CAF) develops after failure of medical treatment of acute anal fissure mostly dueto spasm of internal anal sphincter (IAS), the principals of treatment of (CAF) aim at (IAS) relaxation, lateralinternal sphincterotomy (LIS) is the most popular surgical solution, botulinum toxin (BOTOX) injection is a lessinvasive procedure that achieve chemical sphincterotomy. In this study we are evaluating the outcome of eachprocedure. Two groups of patients with CAF each 48 patients the (BOTOX) group received 80 IU botulinumtoxin injection in the IAS at 1,5,7, and 11 O’clock positions the (LIS) group underwent (LIS) under generalanesthesia. Demographic, preoperative and postoperative outcome data was collected and properly analyzed.Demographic and postoperative data shows non-significant differences between both groups, postoperativepain is significantly less in (BOTOX) group, healing rate was significantly better in (LIS) group, being 37 (77.1%)in (BOTOX) group and 44 (91.7%) in (LIS) group, recurrence rate was significantly higher in (BOTOX) group (5out of healed 37 cases )(13.5%) in (BOTOX) group, and (1 out of healed 44 cases) (2.3%) in (LIS) group. In theearly postoperative time, Incontinence was significantly higher in (BOTOX) group, 8 cases, (16.6%) all of themimproved over time, in (LIS) group 5cases (10.4%) developed incontinence,2 of them (4.2%) werepermanently incontinent to flatus. (BOTOX) injection is safer than (LIS) in treatment of CAF but with lessefficacy, its dose need to be adjusted, (LIS) is more efficient but anal sphincter tone need to be assessed beforethe operation.

[学科分类] 工程和技术（综合）

[关键词] botulinum toxins;sphincterotomy;anal fissure;sphincterotomy