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Am J Surg. 2017 Oct;214(4):623-628. doi: 10.1016/j.amjsurg.2017.06.004. Epub 2017 Jul 5.

Treatment for anal fissure: Is there a safe option?

Author information

1
Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Electronic address: Justin.Brady@UHhospitals.org.
2
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
3
Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
4
Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Surgical Oncology, SECI, Assiut University, Assiut, Egypt.
5
Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Electronic address: Sharon.Stein@uhhospitals.org.

Abstract

BACKGROUND:

Surgeons often approach anal fissure with chemical denervation (Botulinum toxin, BT) instead of initial lateral internal sphincterotomy (LIS) due to concerns for long-term incontinence. We evaluated the characteristics and outcomes of patients who received BT or LIS.

METHODS:

We performed a retrospective chart review of patients undergoing LIS and BT for anal fissure between 2009 and 2015. In 2015, a telephone survey was performed to evaluate durability, long-term incontinence and patient satisfaction.

RESULTS:

Ninety-four patients met criteria: 73 LIS and 21 BT. Age (BT 49 vs. LIS 52) was similar between groups (p = 1.0). Cleveland Clinic Fecal Incontinence (CCFI) score pre-intervention was higher in BT than LIS patients (2.1 vs. 0.4, p = 0.007) with fewer BT patients with perfect continence (50% vs. 88%). Telephone survey response was 61%. Fissure recurrence was significantly higher for BT than LIS patients (36% vs. 9%, p = 0.03).

CONCLUSION:

Patients undergoing LIS were less likely to recur. Both LIS and BT patients had some durable changes in continence raising the question of whether there is a safe technique.

KEYWORDS:

Anal fissure; Anorectal disease; Sphincterotomy

PMID:
28701263
DOI:
10.1016/j.amjsurg.2017.06.004
[Indexed for MEDLINE]

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