A Comparison of Injections of Botulinum Toxin and Topical Nitroglycerin Ointment for the Treatment of Chronic Anal Fissure

Abstract

Although treatment with either topical nitroglycerin or botulinum toxin is effective as an alternative to surgery for patients with chronic anal fissure, botulinum toxin is the more effective nonsurgical treatment.

Anal Fissure Revisited : A Systematic Review

“…In fact, up to 20% of patients cease GTN therapy due to the severity of their headaches. [30], [31], [32], [33] A 2%GTN ointment applied twice to the anoderm for 6 weeks results in a complete healing in 98% of patients. [6] In another study, Topical diltiazem ointment was used as an agent for chemical sphincterotomy for chronic anal fissure.…”

Nifedipine Gel with Lidocaine in the Treatment of Anal Fissure in Children: A Pilot Study and Review of the Literature

“…In all, 78 patients became pain-free within 3 days, and healing rates at 3 and 6 months were 82% and 79%. BT injection was compared with topical GTN (0.2% twice daily) in a randomized trial of 50 chronic anal fissure patients (Brisinda et al, 1999). Resting anal pressure decreased in both groups, but did so to a greater extent in the BT group (29% with BT vs. 14% with GTN at 2 months).…”

Effect of botulinum toxin in selected chronic anal fissure patients: long-term results

“…The following studies investigated its efficacy over topical nitrate therapy and it was found to be a better option (96% vs. 60%). Recently, the use of botulinum toxin in combination with topical nitrates has been shown to be more successful [10,11]. While medium-term results of treatment with botulinum toxin demonstrated a total recovery in 75% of cases in 6 months, the recurrence rate in long-term results was 55% in 3 years and 41.5% in a 42-month period [6,12].…”

“…Patients treated with botulinum toxin presented with fissures having a history of less than 1 year and uncomplicated nature. However, none of our patients had diseases such as diarrhea, irritable bowel syndrome, or diabetes, which are recommended to be checked before LIS by the American Society of Colon and Rectal Surgeons [10,17]. Botulinum toxin was applied at a standard dose of 25 U. Botulinum toxin was injected on both margins of the fissure, at the 9 o'clock position in the lateral aspect.…”