Treatment for anal fissure: Is there a safe option?

• Published in: The American journal of surgery Vol. 214; no. 4; pp. 623 - 628
• Main Authors: Brady, Justin T., Althans, Alison R., Neupane, Ruel, Dosokey, Eslam M.G., Jabir, Murad A., Reynolds, Harry L., Steele, Scott R., Stein, Sharon L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2017; Elsevier Limited
• Subjects: Adult; Age; Anal fissure; Anorectal disease; Botulinum toxin; Botulinum Toxins, Type A - therapeutic use; Colon; Crohns disease; Data collection; Denervation; Durability; FDA approval; Fecal incontinence; Feces; Female; Fissure in Ano - drug therapy; Fissure in Ano - surgery; Humans; Male; Medical personnel; Middle Aged; Neuromuscular Agents - therapeutic use; Obstetrics; Patient Satisfaction; Patients; Practice Patterns, Physicians' - statistics & numerical data; Retrospective Studies; Sphincterotomy; Surgeons; Surgery; Surveys and Questionnaires; Systematic review; Treatment Outcome; Ultrasonic imaging; Anal fissure; Sphincterotomy; Anorectal disease
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2017.06.004

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. 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. 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). 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.