Botulinum Toxin Injection versus Lateral Internal Sphincterotomy in Management of Chronic Anal Fissure. | ||
| Ain Shams Journal of Surgery | ||
| Volume 18, Issue 3, July 2025, Pages 221-228 PDF (490.56 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/asjs.2025.386847.1202 | ||
| Authors | ||
| Mohammed Abdo Etman* ; Alaa Abd ElAzeem Elsisi; Ahmed Ibrahim Saleh; Mohammed N. S. Nassar | ||
| Department of General Surgery, Faculty of Medicine, Menoufia University, Egypt | ||
| Abstract | ||
| Introduction: Anal fissure (AF) is a longitudinal break in the anal mucosa that extends from the anal margin to the dentate line. The internal anal sphincter seldom relaxes on its own, and patients usually have a high resting anal sphincter pressure. For chronic anal fissures, lateral internal sphincterotomy has been the gold standard plan of care. Botulinum toxin injections intrasphincterically appear to be a dependable method for temporarily reducing sphincter spasm and promoting healing of the fissure. Aim of work: This study aimed to evaluate the duration of surgery, length of hospital stay, and postoperative complications between lateral internal sphincterotomy (LIS) and botulinum toxin (BT) in the treatment of chronic anal fissure (CAF). Patients and methods: 82 patients with a CAF who were admited to the Menoufia University Hospital’s Surgical Department for treatment between January 2024 and March 2025 participated in this prospective randomized clinical research. 82 patients were divided into two groups: Group 1 (n=41): underwent intrasphincteric BT injection (BT group). Group 2 (n=41): underwent a conservative LIS (LIS group). Results: While incontinence was substantially lower in group I (Botox group) (P=0.042) than in group II (LIS group), bleeding and urine retention were significantly greater in group II (LIS group) than in group I (Botox group) (P=0.021, 0.048). The incidence of constipation and stenosis varied insignificantly between the two groups. Conclusion: BT injection and LIS are both effective treatment options for CAF. BT injection patients had shorter operative times and hospital stays compared to LIS, making it a less invasive option with quicker recovery. Additionally, pain relief occurred earlier and was more pronounced in the BT group. | ||
| Keywords | ||
| Botulinum toxin injection; lateral internal sphincterotomy; chronic anal fissure | ||
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