Botulinum toxin versus surgical sphincterotomy in females with chronic anal fissure

Objectives: To compare the effectiveness and the morbidity of botulinum toxin (BTX) in the treatment of chronic anal fissure (CAF) versus the standard surgical sphincterotomy. Methods: One hundred female patients with CAF were treated by either closed lateral sphincterotomy [surgical group (Group I, n=50 patients)] or BTX 40 IU [chemical group (Group II, n=50 patients)]. The study was conducted in the King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, over 3 years between January 2004 and December 2006. Results: The healing rate was 100% in surgical group with no recurrence on the period of 3 years follow up and one patient has partial permanent incontinence. While in chemical group the healing rate was 86% (p=0.006). Ten patients had transient incontinence (p=0.014). Seven patients had recurrence within 6 months 14% (p=0.006). Conclusion: We conclude that chemical sphincterotomy is safe, effective first line treatment in selected female patients with CAF.