Does Fissurectomy & Botulinum Toxin A injection for Chronic Anal Fissures decrease the risk of faecal incontinence compared with Lateral Internal Sphincterotomy, whilst promoting healing?

Toquero Lawrence, Mr¹, Sabina Patel, Miss¹, Tayo Oke, Miss². ¹Kings College NHS TRust, ²Queen Elizabeth Hospital NHS Trust

Objective:

The aim of this study was to determine the outcome of Fissurectomy combined with administration of Botulinum Toxin TypeA (F+BTXA) on the healing of medically resistant chronic anal fissures (CAF) over that achieved with BTXA alone and in comparison with the high complication rates of Lateral Sphincterotomy.

Materials and Methods:

14 consecutive patients with CAF who failed eight weeks of GTN/Diltiazem were enrolled, and all underwent F+BTXA (40IU) in the day case setting. Follow-up was at eight weeks, along with subsequent telephone follow-up.

Results:

Completion to follow-up was recorded in nine patients. An overall healing rate of 89% (8/9) was achieved, although one patient had non-healing initially, along with one recurrence (1/9).  The median follow-up period was 5 months. No continence disturbance was recorded. 100% healing rates were recorded in the subset of female patients with obstetric trauma.

Discussion:

Despite relatively low patient recruitment to this study, a short follow-up period and lost data due to a high loss to follow-up rate, successful healing rates of eight-nine percent were recorded, with a zero percent complication rate.

Conclusion:

Combining F+BTXA is an effective and safe treatment option in patients with CAF, and should be considered beneficial in the subset of patients who have previously undergone obstetric trauma.

Despite numerous trials available to confound our results in this trial, only one previous publication has yielded significantly positive statistical evidence to add credence to our postulated theory. A larger Randomized Controlled Trial is required to further elucidate the advantages of this particular technique concentrating on long term recurrence rates, patient centred outcomes and economic costs of the procedure.