Incidence of anal incontinence among patients with anal fissure treated with Botox injection versus lateral sphincterotomy

Ibrahim, Rashid; Abounozha, Sabry; Mohamedahmed, Ali Yasen Y.; Alawad, Awad Ali M.; Rahim, Ahmed Abdel

doi:10.1016/j.amsu.2021.102636

Cited by 2 publications

(4 citation statements)

References 10 publications

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“…Despite these limitations, our study confirms existing evidence that botulinum toxin injection is an efficacious, less-invasive alternative to sphincterotomy for anal fissures and may be associated with reduced occurrence of persistent incontinence of feces or flatus [ 9 ]. Further research and studies are required to go further in-depth into the most effective dosage of botulinum and whether the preparation mode causes a significant change in outcomes.…”

Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

“…Existing evidence suggests that lateral internal sphincterotomy has superior efficacy in healing and reduced recurrence, although botulinum toxin injection has a lower rate of incontinence [6][7][8][9]. However, there remains a lack of consensus on the choice of intrasphincteric botulinum toxin injection versus lateral internal sphincterotomy.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes Following Intrasphincteric Injection of Botulinum Toxin for Treatment of Anal Fissures

Peeroo,

Rajagopalan,

Arachchi

et al. 2024

Cureus

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Background Intrasphincteric injection of botulinum toxin is an alternative treatment for anal fissures, which may present less risk of fecal incontinence than more invasive procedures, such as lateral internal sphincterotomy. The aim is to compare cure and complication rates between these two treatments. Methods We conducted a retrospective audit of patients who underwent treatment of anal fissures with intrasphincteric botulinum toxin or lateral internal sphincterotomy from 2016 to 2020 at the Colorectal Surgery Unit of Monash Health, Melbourne, Australia, excluding those who had previously had either procedure. Results Fifty-one patients received intrasphincteric botulinum toxin, and 40 patients underwent lateral internal sphincterotomy. Most patients in the botulinum group had a total dose of either 80 (53%; n=27) or 100 units (37%; n=19) and had the dose administered bilaterally at the 3 o’clock and 9 o’clock positions (n=41; 80%). Thirty-one patients in the botulinum group (61%) had complete resolution of symptoms, with a mean time to cure of two months, compared to 36 patients (90%) in the sphincterotomy group with a mean time to cure of 1.5 months. In most cases, postoperative incontinence was transient, although one patient in the botulinum group had persistent incontinence of flatus, and two patients in the sphincterotomy group had persistent fecal incontinence. Conclusion Intrasphincteric botulinum injection is an effective, less-invasive alternative to sphincterotomy for the treatment of anal fissures, with incontinence usually temporary when it occurs. Further research is needed to optimize the dose and location of injection and guide future recommendations.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes Following Intrasphincteric Injection of Botulinum Toxin for Treatment of Anal Fissures

Peeroo,

Rajagopalan,

Arachchi

et al. 2024

Cureus

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“…Yet the infrequent but devastating complication of fecal incontinence has led many surgeons to defer this procedure as a last resort option. However, incontinence secondary to LIS has been substantially reduced from 10% before 2000 to 3.4% between 2000 and 2017, as reported in the literature [12 ▪ ,13]. This decrease is attributed to improved surgical technique, namely, limiting division of the internal anal sphincter to the level of the fissure as opposed to the dentate line as classically described.…”

Section: Text Of Reviewmentioning

confidence: 81%

‘Bumps down under:’ hemorrhoids, skin tags and all things perianal

Alvarez-Downing

Silva

2021

Current Opinion in Gastroenterology

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Purpose of reviewThere continues to be a concentrated effort to improve treatment options readily available for some of the most common perianal diseases: hemorrhoids, anal fissure and anal fistula. The emphasis remains on therapies that definitively address the underlying pathology yet minimize pain and risk of incontinence, have a short recovery period, and are cost-effective. In this analysis, recent developments in the literature are reviewed. Recent findingsTreatment of early stage hemorrhoidal disease remains the same. For grades II-IV disease, hemorrhoidal vessel ligation/obliteration with laser or bipolar energy are reported. For more advanced diseases, modifying the technique for hemorrhoidectomy to improve postoperative complications and pain is described. For anal fissure, a stepwise method continues to be the mainstay of treatment (initiating with vasodilators, followed by botox, and ultimately sphincterotomy), which decreases the risk of incontinence with proper patient selection and technique. Management of anal fistula continues to be challenging, balancing cure vs. risk of harm. Recent developments include modifications to ligation of intersphincteric fistula tract procedure and use of laser to obliterate the tract. SummaryAdvancements in managing benign anorectal disease are ongoing. Several reports are novel, whereas others involve enhancing well-established treatment options by either operative technique or patient selection.

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Incidence of anal incontinence among patients with anal fissure treated with Botox injection versus lateral sphincterotomy

Cited by 2 publications

References 10 publications

Outcomes Following Intrasphincteric Injection of Botulinum Toxin for Treatment of Anal Fissures

Outcomes Following Intrasphincteric Injection of Botulinum Toxin for Treatment of Anal Fissures

‘Bumps down under:’ hemorrhoids, skin tags and all things perianal

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