Unilateral Botox injection, tailored Sphincterotomy in treatment of Chronic Anal Fissure :A Randomized comparative trial | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 43, Issue 4, October 2024, Page 1548-1553 PDF (322.84 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/EJSUR.2024.298466.1105 | ||||
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| Authors | ||||
Mohamed Mohsen  ; Waleed Thabet; Emad E. Abdallah; Hesham Noor
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| Department of General Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt | ||||
| Abstract | ||||
| Background: Anal fissures, longitudinal tears in the anal canal, can become chronic if unhealed after 8–12 weeks. Treatment options for chronic fissures include Botulinum toxin (Botox) injections and tailored lateral internal sphincterotomy (LIS). Objective: This study aimed to compare the effectiveness and safety of unilateral Botox injection versus tailored LIS for treating chronic anal fissures. Patients and Methods: A single-blinded, randomized, controlled trial was conducted on patients with chronic anal fissure at Mansoura University Hospital from September 2021 to February 2023. Patients were randomly assigned to receive either unilateral Botox injection (group A, n=35) or tailored LIS (group B, n=35). Pre- and postoperative assessments included clinical examination, manometry, and evaluation of incontinence and recurrence rates. Results: The mean operative time was significantly longer in group B (11.46±1.82 min) compared with group A (6.11±1.59 min, P<0.001). Wound healing was faster in group A (5.43±1.70 days) versus group B (10.83±2.20 days, P<0.001). Recurrence rates were lower in group B (22.9%) compared with group A (42.9%, P=0.075). Incontinence to flatus was lower in group B (22.9%) than in group A (40%, P=0.122). Incontinence to solid stool was absent in group B but present in 11.4% of group A (P=0.039). Conclusion: Tailored lateral internal sphincterotomy showed superior long-term outcomes in recurrence and incontinence compared with unilateral Botox injection. Despite a longer healing period, tailored LIS should be preferred for managing chronic anal fissures. | ||||
| Keywords | ||||
| Anal fissure; anal incontinence; Botox injection; chronic anal fissure treatment; tailored lateral sphincterotomy | ||||
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