مقايسه اثر تزريق توكسين بوتوليسم و نيتروگليسيرين موضعي در درمان شقاق مزمن مقعد

THE COMPARISON BETWEEN INJECTIONS OF BOTULINUM TOXIN AND TOPICAL NITROGLYCERIN OINTMENT FOR TREATMENT OF CHRONIC ANAL FISSURE

Anal fissure is a common disease of anorectal area. The cause of anal fissure is anal sphincter spasm and elevation of anal pressure which has been confirmed by manometry studies. The aim of treating fissure is to reduce sphincter tone and pressure. lu this study, two methods of medical treatment of chronic anal fissure without causing fecal incontinence were compared. Sixty patients were randomly divided into two equal groups. One group was treated by local injection of 80 ua botulinum toxin inside anal sphincter anteriorly and along both sides of mid line. The other group was managed by local application of nitroglycerin ointment 0.3% two times a day for a period of 4-8 weeks. Wound healing and symptom improvement occurred in 27 out of 30 patients (90%) in the botulinum group and 24 out of 29 patients (80%) in the nitrate group. In the botulinum group, temporary fecal incontinence was reported in one patient. In the nitrate group, 5 patients suffered from headache (16.7%) which was transiant or treated by oral acetaminophen. One patient with headache was treated by switching to botulinum therapy which was successful. Tolerable anal burning was present in 2 patients (6.67%) . One patient who did not respond to botulinum toxin was succesfully treated with nitroglycerin ointment. Two patients were subjected to surgical procedure. Five patients failed. to respond to nitroglycerin. Therefore, changing to botulinum therapy or surgical procedure were suggested for them. Recurrent rate in the nitrate group was 16.6% (4 cases) and 7.4% in the botulinum group (2 cases). Betulinum is much more effective than nitroglycerin as a substitution for surgical procedure in the managment of patients with chronic anal fissure.