Botulinum Toxin Injection versus Lateral Internal Sphincterotomy in Management of Chronic Anal Fissure.

Document Type : Original Article

Authors

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

Files

Share

How to cite

Statistics