Botulinum toxin versus surgical sphincterotomy in females with chronic anal fissure.

Abstract

OBJECTIVES To compare the effectiveness and the morbidity of botulinum toxin (BTX) in the treatment of chronic anal fissure (CAF) versus the standard surgical sphincterotomy. METHODS 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. RESULTS 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). CONCLUSIONS We conclude that chemical sphincterotomy is safe, effective first line treatment in selected female patients with CAF.