Annals of Coloproctology

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Clinical trial of combining botulinum toxin injection and fissurectomy for chronic anal fissure: a dose-dependent study: Nuha Alsaleh, Abdullah I. Aljunaydil, Gaida A. Aljamili; Received March 24, 2021 Accepted July 27, 2021 Published online December 3, 2021; DOI: https://doi.org/10.3393/ac.2021.00213.0030 [Epub ahead of print]

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2 Citations

Purpose
Our aim was to evaluate the effectiveness of combining fissurectomy with botulinum toxin A injection in treating chronic anal fissures.
Methods
A single surgeon in Saudi Arabia conducted a nonrandomized prospective cohort study between October 2015 and July 2020. The cohort included 116 female patients with chronic anal fissures, with a mean age of 36.57±11.52 years, who presented to the surgical outpatient clinic and received a botulinum toxin injection combined with fissurectomy. They were followed up with at 1, 2, 3, 4, and 8 weeks to evaluate the effects of the treatment, then again at 1 year. The primary outcome measures were symptomatic relief, complications, recurrence, and the need for further surgical intervention.
Results
Treatment with botulinum toxin A combined with fissurectomy was effective in 99.1% of patients with chronic anal fissures at 1 year. Five patients experienced recurrence at 8 weeks, which resolved completely with a pharmacological sphincterotomy. Twelve patients experienced minor incontinence, which later disappeared. Pain completely disappeared in more than half of the patients (55.2%) within 7 to 14 days. Pain started to improve in less than 8 days among patients treated with a dose of 50±10 IU (P=0.002).
Conclusion
Seventy units of botulinum toxin A injection combined with a fissurectomy is a suitable second-line treatment of choice for chronic anal fissures, with a high degree of success and low rate of major morbidity.

Citations

Citations to this article as recorded by

Fissurectomy with mucosal advancement flap anoplasty: The end of a dogma?
M. Skoufou, J.H. Lefèvre, A. Fels, N. Fathallah, P. Benfredj, V. de Parades
Journal of Visceral Surgery.2023; 160(5): 330. CrossRef
La fissurectomie avec anoplastie muqueuse : la fin d’un dogme ?
Maria Skoufou, Jérémie H. Lefèvre, Audrey Fels, Nadia Fathallah, Paul Benfredj, Vincent de Parades
Journal de Chirurgie Viscérale.2023; 160(5): 363. CrossRef

Benign proctology,Surgical technique

Minimal Lateral Internal Sphincterotomy (LIS): Is It Enough to Cut Less Than the Conventional Tailored LIS?: Keun-Hee Lee, Keehoon Hyun, Seo-Gue Yoon, Jong-Kyun Lee; Ann Coloproctol. 2021;37(5):275-280. Published online July 9, 2021; DOI: https://doi.org/10.3393/ac.2020.00976.0139

23,787 View
230 Download
9 Web of Science
11 Citations

Abstract PDF

Purpose
Anal fissure is a common anorectal condition, yet its pathogenesis remains unclear. Lateral internal sphincterotomy (LIS) is the gold standard treatment for chronic anal fissures that do not respond to conservative treatment; however, it has a risk of anal incontinence. We believe that fibrosis of the internal anal sphincter is an important factor in the pathogenesis of chronic anal fissure. In this study, we describe the minimal LIS method, a minimally invasive method where only the fibrotic portion of the internal anal sphincter is cut. We also describe the outcomes of this method.
Methods
We performed a retrospective review of 468 patients (270 male and 198 female) who underwent minimal LIS for chronic anal fissure in 2017 at Seoul Song Do Hospital. We analyzed the patients’ clinical characteristics, manometry data, complications, and outcomes of minimal LIS. The outcomes of the surgery were assessed via questionnaires during the postoperative outpatient visits, beginning 2 weeks postoperatively.
Results
The overall complication rate was 4.0% (19 patients). Delayed healing occurred in 14 patients (3.0%), perianal abscess was present in 3 patients (0.6%), and gas incontinence occurred in 2 patients (0.4%). All complications were improved with conservative treatment. Recurrence, defined as the recurrence of anal fissure more than 4 weeks after healing, was present in 6 patients (1.3%).
Conclusion
Minimal LIS is a safe and effective treatment option for patients with chronic anal fissure. Postoperative complications, especially incontinence and recurrence, are rare.

Citations

Citations to this article as recorded by

Operative Therapie der Analfissur
Ricarda Diller
coloproctology.2025; 47(4): 254. CrossRef
Current evidence and new trends in anal fissure treatment
Marta DOMÍNGUEZ-MUÑOZ, Andrea BALLA, Juan Carlos GÓMEZ-ROSADO, Salvador MORALES-CONDE
Minerva Surgery.2025;[Epub] CrossRef
The Practices and Preferences of Turkish Surgeons in the Treatment of Anal Fissure
Ümit Özdemir, Necip Tolga Baran, Ahmet Seki
Journal of Coloproctology.2025; 45(03): 001. CrossRef
Management of Hemorrhoids and Anal Fissures
Oladapo Akinmoladun, William Oh
Surgical Clinics of North America.2024; 104(3): 473. CrossRef
Anal Fissure and Its Treatments: A Historical Review
Cristiana Riboni, Lucio Selvaggi, Francesco Cantarella, Mauro Podda, Salvatore Bracchitta, Vinicio Mosca, Angelo Cosenza, Vincenzo Cosenza, Francesco Selvaggi, Bruno Nardo, Francesco Pata
Journal of Clinical Medicine.2024; 13(13): 3930. CrossRef
Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials
Ali Bonyad, Reza Hossein Zadeh, Setareh Asgari, Fatemeh Eghbal, Pardis Hajhosseini, Hani Ghadri, Niloofar Deravi, Reza Shah Hosseini, Mahdyieh Naziri, Rasoul Hossein Zadeh, Yaser khakpour, Sina Seyedipour
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
Modern trends and priority in treatment of chronic anal fissure
S. A. Aliev, E. S. Aliev
Grekov's Bulletin of Surgery.2024; 183(4): 77. CrossRef
New Findings at the Internal Anal Sphincter on Cadaveric Dissection and Review of Sphincter-Related Surgery in a Newer Prospective
Aswini Kumar Pujahari
Indian Journal of Surgery.2023; 85(3): 585. CrossRef
Long-term Efficacy and Safety of Controlled Manual Anal Dilatation in the Treatment of Chronic Anal Fissures: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki, Yusuke Saitoh, Masanori Murakami
Journal of the Anus, Rectum and Colon.2023; 7(4): 250. CrossRef
The Association of Coloproctology of Great Britain and Ireland guideline on the management of anal fissure
Katie L. R. Cross, Steven R. Brown, Jos Kleijnen, James Bunce, Melanie Paul, Sophie Pilkington, Oliver Warren, Oliver Jones, Jon Lund, Henry J. Goss, Michael Stanton, Tatenda Marunda, Artaza Gilani, L. Wee Sing Ngu, Philip Tozer
Colorectal Disease.2023; 25(12): 2423. CrossRef
Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef

Benign proctology,Functional outcome

The Long-term Effect of Standardized Anal Dilatation for Chronic Anal Fissure on Anal Continence: Ilia Pinsk, David Czeiger, Daria Lichtman, Avraham Reshef; Ann Coloproctol. 2021;37(2):115-119. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2020.03.16

11,531 View
217 Download
8 Web of Science
10 Citations

Abstract PDF

Purpose
For the past several decades, internal anal sphincterotomy has generally been considered to be the standard operation for an anal fissure. However, wound complications inherent in this operation forced surgeons to look for an alternative form of treatment. The aim of our study was to evaluate the long-term outcome of anal dilatation for chronic anal fissure, especially possible negative impact on anal sphincter function.
Methods
The study was approved by the local Institutional Review Board and given a waiver of written consent. A phone call survey was undertaken among a group of consecutive patients who had an anal dilatation by standardized technique for chronic anal fissure for the period between 2000 and 2016. The survey included medical, obstetrical and surgical-related data, Wexner fecal incontinence score, recurrence of the anal fissure, and the need for additional medical intervention. Five hundred 48 patients were identified after limitations of age, concomitant pathology, and procedures that were applied to the hospital computerized database. Eighty-five patients (group A) agreed to participate in the survey and 463 patients did not.
Results
There were no differences between groups in demographic information and medical records data; therefore, group A may well represent a satisfactory sample of the whole group. The interval between the procedure and the survey was 6.8 ± 2.7 years. The Wexner incontinence score was 0 in 94% of patients.
Conclusion
Anal dilatation, performed in a systematic and standardized way, has a successful outcome with no complications and has no clear long-term negative impact on anal sphincter function.

Citations

Citations to this article as recorded by

Early Outcomes of Hirschsprung's Disease after Definitive Surgery: A Ten-year Experience
Muntadhar Muhammad Isa, Maimun Syukri, Muchlisin Zainal Abidin, Dian Adi Syahputra, Teuku Yusriadi, Yumna Muzakkir, Siti Magfirah, Gunadi Gunadi
Current Pediatric Reviews.2025; 21(4): 384. CrossRef
Сontrolled circular dilatation and lateral subcutaneous sphincterotomy for chronic anal fissures associated with hemorrhoids III-IV
Z. Z. Kamaeva, A. Yu. Titov, R. Yu. Khryukin, I. S. Anosov, Yu. A. Shelygin
Koloproktologia.2024; 23(1): 42. CrossRef
Modern trends and priority in treatment of chronic anal fissure
S. A. Aliev, E. S. Aliev
Grekov's Bulletin of Surgery.2024; 183(4): 77. CrossRef
New Findings at the Internal Anal Sphincter on Cadaveric Dissection and Review of Sphincter-Related Surgery in a Newer Prospective
Aswini Kumar Pujahari
Indian Journal of Surgery.2023; 85(3): 585. CrossRef
A systematic review of translation and experimental studies on internal anal sphincter for fecal incontinence
Minsung Kim, Bo-Young Oh, Ji-Seon Lee, Dogeon Yoon, Wook Chun, Il Tae Son
Annals of Coloproctology.2022; 38(3): 183. CrossRef
The role of dilatation methods and lateral subcutaneous sphincterotomy in the internal anal sphincter spasm treatment (systematic literature review and meta-analysis)
Z. Z. Kamaeva, A. Yu. Titov, A. A. Ponomarenko, R. Yu. Khrukin, I. S. Anosov, Yu. A. Shelygin
Hirurg (Surgeon).2022; (4): 19. CrossRef
Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef
The role of percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic anal fissure: a systematic review
Konstantinos Perivoliotis, Ioannis Baloyiannis, Dimitrios Ragias, Nikolaos Beis, Despoina Papageorgouli, Emmanouil Xydias, Konstantinos Tepetes
International Journal of Colorectal Disease.2021; 36(11): 2337. CrossRef
Anorectal emergencies: WSES-AAST guidelines
Antonio Tarasconi, Gennaro Perrone, Justin Davies, Raul Coimbra, Ernest Moore, Francesco Azzaroli, Hariscine Abongwa, Belinda De Simone, Gaetano Gallo, Giorgio Rossi, Fikri Abu-Zidan, Vanni Agnoletti, Gianluigi de’Angelis, Nicola de’Angelis, Luca Ansaloni
World Journal of Emergency Surgery.2021;[Epub] CrossRef
Safety and efficacy of the treatment of chronic anal fissure by lateral internal sphincterotomy: A retrospective cohort study
Fatma Al-thoubaity
Annals of Medicine and Surgery.2020; 57: 291. CrossRef

Sphincter-Preserving Therapy for Treating a Chronic Anal Fissure: Long-term Outcomes: Ridzuan Farouk; Ann Coloproctol. 2014;30(3):132-134. Published online June 23, 2014; DOI: https://doi.org/10.3393/ac.2014.30.3.132

11,839 View
66 Download
15 Web of Science
13 Citations

Abstract PDF

Purpose

To estimate the risk of recurrent fissure in ano after sphincter preserving treatments.

Methods

A retrospective case note review, combined with a telephone survey was conducted for all patients treated for a chronic anal fissure between 1998 and 2008.

Results

Six hundred and twelve patients (303 women: mean age, 39 years; range, 16-86 years) were treated for chronic anal fissure between 1998 and 2008. Topical diltiazem 2% was initially prescribed for 8 weeks. The fissure did not heal in 141 patients. These patients (61 women: mean age, 30 years; range, 15-86 years) were treated with 100 IU botulinum A toxin (Botox) injection combined with a fissurectomy under general anaesthesia. Thirty eight patients suffered a recurrence of their fissure within two years. Thirty-four healed with further medical or sphincter conserving surgical therapy while four required a lateral internal sphincterotomy.

Conclusion

The vast majority of patients with chronic anal fissure can be treated with sphincter conserving treatments. This may require several interventions before healing can be achieved. Assessment for recurrence after 'conservative' treatments requires a minimum of two-year follow-up.

Citations

Citations to this article as recorded by

Effectiveness of combined botulinum toxin and fissurectomy on chronic anal fissures – a systematic review
Rakesh Quinn, Giuleta Jamsari, Gary KK Low, Sinan Albayati
ANZ Journal of Surgery.2025; 95(3): 293. CrossRef
Study on duration of symptoms of anal fissure and its impact on response to conservative treatment – A systemic review
Kamal Raut
Journal of Preventive Medicine and Holistic Health.2024; 10(2): 43. CrossRef
The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures
Jennifer S. Davids, Alexander T. Hawkins, Anuradha R. Bhama, Adina E. Feinberg, Michael J. Grieco, Amy L. Lightner, Daniel L. Feingold, Ian M. Paquette
Diseases of the Colon & Rectum.2023; 66(2): 190. CrossRef
Fisurectomy and anoplasty with botulinum toxin injection in patients with chronic anal posterior fissure with hypertonia: a long-term evaluation
Beatrice D’Orazio, Girolamo Geraci, Guido Martorana, Carmelo Sciumé, Giovanni Corbo, Gaetano Di Vita
Updates in Surgery.2021; 73(4): 1575. CrossRef
S3-Leitlinie: Analfissur
Lukas Marti, Stefan Post, Alexander Herold, Oliver Schwandner, Franc Hetzer, Bernhard Strittmatter, Igors Iesalnieks, Marcus Huth, Martin Schmidt-Lauber, Gerhard Weyandt, Andreas Ommer, Sabrina M. Ebinger
coloproctology.2020; 42(2): 90. CrossRef
Anoplastia com plicoma sentinela para o tratamento de fissura anal crônica.
Carlos Walter Sobrado Júnior, José Américo Bacchi Hora, Lucas Faraco Sobrado, Vivian Regina Guzela, Sérgio Carlos Nahas, Ivan Cecconello
Revista do Colégio Brasileiro de Cirurgiões.2019;[Epub] CrossRef
Long‐term outcomes of Botulinum toxin in the treatment of chronic anal fissure: 5 years of follow‐up
Sandra Barbeiro, Catarina Atalaia‐Martins, Pedro Marcos, Cláudia Gonçalves, Manuela Canhoto, Bruno Arroja, Filipe Silva, Isabel Cotrim, Liliana Eliseu, Antonieta Santos, Helena Vasconcelos
United European Gastroenterology Journal.2017; 5(2): 293. CrossRef
Efficacy of nitroglycerine ointment in the treatment of pediatric anal fissure
Ali E. Joda, Ali F. Al-Mayoof
Journal of Pediatric Surgery.2017; 52(11): 1782. CrossRef
High-dose versus low-dose botulinum toxin in anal fissure disease
P. Ravindran, D. L. Chan, C. Ciampa, R. George, G. Punch, S. I. White
Techniques in Coloproctology.2017; 21(10): 803. CrossRef
Pathophysiology of fecal incontinence differs between men and women: a case‐matched study in 200 patients
D. C. Townsend, E. V. Carrington, U. Grossi, R. E. Burgell, J. Y. J. Wong, C. H. Knowles, S. M. Scott
Neurogastroenterology & Motility.2016; 28(10): 1580. CrossRef
Treatment of Gastrointestinal Sphincters Spasms with Botulinum Toxin A
Giuseppe Brisinda, Nicola Sivestrini, Giuseppe Bianco, Giorgio Maria
Toxins.2015; 7(6): 1882. CrossRef
Prospective multicenter observational trial on the safety and efficacy of LEVORAG® Emulgel in the treatment of acute and chronic anal fissure
R. Digennaro, G. Pecorella, S. La Manna, A. Alderisio, A. Alderisio, B. De Pascalis, D. Pennisi, G. Santangelo, F. Pezzolla, A. Racalbuto, G. Serra, A. Pulvirenti D’Urso, D. F. Altomare
Techniques in Coloproctology.2015; 19(5): 287. CrossRef
Treatment Option for Aged, Multiparous Women With a Chronic Anal Fissure
Yong Hee Hwang
Annals of Coloproctology.2014; 30(3): 106. CrossRef

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