Long-term follow-up after combined fissurectomy and Botox injection for chronic anal fissures

Abstract

Combined fissurectomy and Botox injection for chronic anal fissure is an excellent and safe procedure with low morbidity and a high healing rate.

Fissurectomy combined with anoplasty and injection of botulinum toxin in treatment of anterior chronic anal fissure with hypertonia of internal anal sphincter: a pilot study

“…Among the drugs most commonly used for the pharmacological sphincterotomy, the botulinum toxin is better tolerated by patients due to high compliance associated with a low incidence of related side effects [35]. The botulinum toxin injection associated with the fissurectomy for the treatment of CAF has been reported by other authors [23,[36][37][38] with a high success rate and low morbidity. The botulinum toxin acts determining a weakness of internal sphincter with the reduction of MRP and improving the arterial blood flow in the anoderm.…”

Conservative and Surgical Treatment of Chronic Anal Fissure: Prospective Longer Term Results

“…The proximal extent of LIS up to the apex of fissure, although associated with a delayed healing and increased recurrences, 16,35,61 minimizes the risk of continence disturbance. Proximal extent of LIS is particularly important in female patients because of the shorter length of the internal sphincter and vaginal deliveries that have been found to a be a significant risk factor of incontinence after LIS.…”

“…25 Fissurectomy enhances healing removing the fibrotic fissure edges, unhealthy granulation tissue at the base, and the sentinel pile when present. 25,61 Fissurectomy alone creates in essence an acute fissure with fresh wound edges, but does not address the underlying IAS spasm at the base of CAF pathogenesis. Few authors suggested that higher rates of fissure healing could be achieved if fissurectomy is combined with conservative pharmacological sphincterotomy.…”

“…12 It is likely that the fibrotic nature of chronic fissures resistant to GTN is not resolved by chemical sphincterotomy alone. Fissurectomy alone is not currently used in adults, but its combination with botulinum toxin injection has been recently used with success to treat fissures resistant to medical treatment, [13][14][15] with healing rates higher than 90% (not far from LIS), and with negligible risk of incontinence.…”

Advancement flap in the management of chronic anal fissure: a prospective study

“…They combined local isosorbide dinitrate with fissurectomy in 15 patients and described healing rates of 100 % within a follow-up of 29 months [22]. Few recent studies [4,[23][24][25][26][27][28] To cover the exposed area after fissurectomy, an advancement skin graft has been mostly used. Only recently, a mucosal advancement flap has been used [29,30].…”