Influence of botulinum toxin site of injections on healing rate in patients with chronic anal fissure

Maria, Giorgio; Brisinda, Giuseppe; Bentivoglio, Anna Rita; Cassetta, Emanuele; Gui, Daniele; Albanese, Alberto

doi:10.1016/s0002-9610(99)00255-x

Cited by 124 publications

(82 citation statements)

References 26 publications

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“…Injections in the ventral part of the internal anal sphincter give better results than injections in the dorsal part [33]. No manometric data were obtained in this study, but BT-A has already proven to lower anal resting pressures [11,12,13,14].…”

Section: Discussionmentioning

confidence: 87%

Botulinum Toxin A Injection in ISDN Ointment-Resistant Chronic Anal Fissures

Witte

Klaase

2007

Dig Surg

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Background: In the treatment of chronic anal fissures (CAFs), surgical sphincterotomy is more commonly being replaced by chemical sphincterotomy. After the good results of our pilot study including 32 patients, we now describe the effect of botulinum toxin A (BT-A) in a consecutive series of 100 patients with isosorbide dinitrate (ISDN) ointment-resistant CAFs. Methods: From October 2002 until August 2005, 100 patients (52 males, 48 females) with a median age of 45 (20–79) years were treated with an injection of 40–100 IU BT-A (Dysport®, Ipsen, The Netherlands) in the internal anal sphincter. Results: After a median follow-up of 10 (4–38) months, 77 of the 100 CAFs (77%) were cured. 20 patients were given a second injection, 1 a third and 1 a fourth injection. In 11 patients a fissure recurred (14%). In 1 patient (1%) there was temporary incontinence due to flatus. Conclusion: With an early response rate of 77% and an overall success rate of 66%, BT-A injections appear to be effective in patients with ISDN ointment-resistant CAFs if initial non-responders are retreated. These results are in concordance with the results of our pilot study. It is a simple technique with little or no side effects, that does not compromise future treatments. Its place in the first-line treatment of CAFs should be investigated further.

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Section: Discussionmentioning

confidence: 87%

Botulinum Toxin A Injection in ISDN Ointment-Resistant Chronic Anal Fissures

Witte

Klaase

2007

Dig Surg

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“…[11] [12] Retrograde endoscopic delivery of BOTOX® (Allergan, Inc., Irvine, CA) into the internal anal sphincter has also been described as being more accurate and better tolerated by patients in one group. [12] The value of this dosing regime awaits validation.…”

Section: Methodsmentioning

confidence: 99%

Anal Fissure Revisited : A Systematic Review

Singh¹,

Chandrakar²,

Agrawal³

et al. 2015

jemds

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Anal fissure is one of the most common anorectal problems. Anal fissure is largely associated with high anal sphincter pressures and most treatment options are based on reducing anal pressures. There are many options to treat chronic fissures in ano. Some of them are non-surgical while the others are surgical. The efficacy claimed by each of the prevalent method is very high but the inconsistencies and contraindications are equally strong. To date, lateral sphincterotomy has been favoured by most of the proctologists, because it is the least extensive surgical procedure and is offering a long lasting relief in sphincter spasm. Various management technique are reviewed in this article along with Advancement flap for anterior fissure and a new method combining the age-old technique of Lord's manual dilatation followed by radio surgery is also highlighted along with their complications. The addition of radio surgery is found useful for refreshing the edges of the fissure and to tackle pathologies namely sentinel pile, small internal piles or hypertrophied anal papillae often found associated with chronic fissures. Revisiting the trends of treatment of chronic anal fissures, the most preferred options are the manual dilatation with radio surgery and the subcutaneous lateral anal sphincterotomy. Both methods are easy to perform, have negligible complications and no special setup is needed, except the radio surgical unit, in case of the first procedure.

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“…One prospective randomized study showed that botulinum toxin had a better healing rate compared to 0.2% GTN ointment [47] . It may be beneficial to repeat the injection of botulinum toxin for patients with recurrent fissures [48,49] . There is no conclusion on the optimal dose of the toxin, the number of injections, or the precise site of injection.…”

Section: Treatmentmentioning

confidence: 99%

What every gastroenterologist needs to know about common anorectal disorders

Schubert¹,

Sridhar²,

Schade³

et al. 2009

WJG

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Anorectal complaints are very common and are caused by a variety of mostly benign anorectal disorders. Many anorectal conditions may be successfully treated by primary care physicians in the outpatient setting, but patients tend not to seek medical attention due to embarrassment or fear of cancer. As a result, patients frequently present with advanced disease after experiencing significant decreases in quality of life. A number of patients with anorectal complaints are referred to gastroenterologists. However, gastroenterologists' knowledge and experience in approaching these conditions may not be sufficient. This article can serve as a guide to gastroenterologists to recognize, evaluate, and manage medically or nonsurgically common benign anorectal disorders, and to identify when surgical referrals are most prudent. A review of the current literature is performed to evaluate comprehensive clinical pearls and management guidelines for each topic. Topics reviewed include hemorrhoids, anal fissures, anorectal fistulas and abscesses, and pruritus ani.

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Influence of botulinum toxin site of injections on healing rate in patients with chronic anal fissure

Cited by 124 publications

References 26 publications

Botulinum Toxin A Injection in ISDN Ointment-Resistant Chronic Anal Fissures

Botulinum Toxin A Injection in ISDN Ointment-Resistant Chronic Anal Fissures

Anal Fissure Revisited : A Systematic Review

What every gastroenterologist needs to know about common anorectal disorders

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