Short-Term Outcomes Following Intrasphincteric Injection of Botulinum Toxin in Patients with Chronic Anal Fissure
Keywords:
Chronic anal fissure; Botulinum toxin; Chemical sphincterotomy; Healing; Incontinence; RecurrenceAbstract
Introduction: Chronic anal fissure is a common benign anorectal condition characterized by severe pain during defecation, bleeding, and impaired quality of life. Botulinum toxin injection has emerged as a minimally invasive alternative to lateral internal sphincterotomy by inducing temporary chemical sphincterotomy and reducing resting anal sphincter pressure. This study aims to evaluate the shortterm clinical outcomes of intrasphincteric botulinum toxin injection in patients with chronic anal fissure.
Methods: This quasi-experimental study was conducted in the Department of Colorectal Surgery, Bangladesh Medical University (BMU), Dhaka, Bangladesh, between January 2023 and January 2024. Fifty-five adult patients with chronic anal fissure refractory to medical therapy were included. Botulinum toxin was injected into the internal anal sphincter as an office-based procedure. Patients were followed at 1, 4, and 12 weeks. Outcome measures included pain relief, bleeding, incontinence, fissure healing, and recurrence.
Results: The mean age of the patients was 43.9 ± 9.5 years, and 81.8% were female. The most common fissure location was posterior (78.2%). Pain was present in 25.5% of patients at 1 week and 1.8% at 4 weeks, while no patient reported pain at 12 weeks. Temporary flatus incontinence occurred in one patient (1.8%) during the first week and resolved completely thereafter. No postoperative bleeding was observed. Fissure healing was achieved in 49.1% of patients at 1 week, 74.5% at 4 weeks, and 92.7% at 12 weeks. Recurrence was observed in four patients (7.3%).
Conclusion: Intrasphincteric botulinum toxin injection is a safe and effective minimally invasive treatment for chronic anal fissure, providing high healing rates with minimal morbidity, negligible incontinence, and low recurrence during short-term follow-up.
Journal of Surgical Sciences 2024;28(2): 85-89
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