Therapeutic effects of different doses of botulinum toxin in chronic anal fissure

Mínguez, Miguel; Melo, Francisco Tiago de Vasconcelos; Espí, Alejandro; García‐Granero, Eduardo; Mora, Francisco; Lledó, Salvador; Benages, A

doi:10.1007/bf02236694

Cited by 137 publications

(108 citation statements)

References 20 publications

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“…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: 92%

“…Botulinum toxin A (BT-A) is a new development in the treatment of CAFs. By injecting BT-A in the internal anal sphincter it temporarily reduces internal anal sphincter resting pressure, allowing fissures to heal [11,12,13,14]. After the promising results of 32 patients in our pilot study [15], we now evaluate the effect of BT-A injections in the first 100 consecutive patients with CAFs.…”

Section: Introductionmentioning

confidence: 99%

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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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“…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: 92%

Section: Introductionmentioning

confidence: 99%

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

Witte

Klaase

2007

Dig Surg

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“…Doses have varied between 5 to 100 units of BOTOX®, with various studies suggesting a dose-dependent efficacy of BOTOX® treatment. [13] [14] Compared with placebo, injection of botulinum toxin into the internal anal sphincter has been shown to be significantly better at healing anal fissures (73%) and in symptomatic relief (87%) at 2-month follow up. [15] Various randomized prospective studies have compared botulinum toxin injection with glyceryl trinitrate for the treatment of chronic anal fissures.…”

Section: Methodsmentioning

confidence: 99%

“…[17] Overall recurrence of anal fissure with botulinum toxin therapy is common (up to 55%), but retreatment with a higher dose may be effective. [13] [18] The main side effect with botulinum toxin injection is mild incontinence to flatus and stool, lasting up to 3 weeks. [18] Although the risk is significantly lower compared with lateral internal sphincterotomy, there have been two case reports of long-term fecal incontinence with botulinum toxin injection of the anal canal.…”

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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“…[14][15][16] A recent Cochrane review and meta-analysis concluded however that the neither the dose nor the type of Botox injected altered healing rates.…”

mentioning

confidence: 99%