Treatment Option for Anal Fissure- Chemical or Surgical?

Abstract

Background: Anal fissure is treated surgically with lateral internal sphincterotomy (LIS) or by chemical denervation using Botulinum toxin (Botox). Due to fear of incontinence surgeons used Botox instead of LIS. In this study we evaluated the outcome of LIS & Botox treatment in patients with anal fissure. Objective: The aim of our study was compare the satisfaction rate of patients, recurrence and incontinence in Botox vs LIS.  Study Design: Prospective study. Settings: University of Lahore, Lahore Pakistan. Duration: From 2018 to 2019. Methods: Its prospective study from 2018 to 2019 to find out the outcome of LIS vs Botox in patients suffering from anal fissure in regard of patient satisfaction and incontinence. Results: Study included 71 patients who met the criteria, 52 patients underwent lateral sphincterotomy and 19 patients got Botulinum toxin injection with median age of 47 for LIS and 39 for Botox. Cleveland Clinic Fecal Incontinence (CCFI) score was higher in Botox than LIS patients (2.3 vs0.6, P=0.006) and continence was about 52% in Botox vs 91% for LIS. Recurrence rate was quite high in Botox than LIS patients (40% vs 7%, P=0.04). Conclusion:  The recurrence rate is quite low in LIS. However, regarding continence outcome, both procedures may need a safe approach.