بررسي اثرات درماني تزريق سم بوتولينيوم در درمان شقاق مزمن مقعد

Evaluation of the Effect of Botulinum Toxin in the Management of Chronic Anal Fissure

Anal fissure is a common and painful anorectal disease in adolescence which presents in acute and chronic forms. In the acute phase conservative management is 95% effective and consists of high fiber diets, laxatives, and local anaesthetic ointments. When chronic sign and symptoms (hypertrophic papilla, sentinel pile) occur, the fissure is managed by partial lateral internal sphincterotomy (LATS). LATS operation is still the best choice, however such aggressive management has complications such as development of incontinence. In recent years chemical sphincterotomy with glyceryl trinitrate (GTN) , botulinum toxin, diltiazem ointments have been used. We attempted to evaluate botulinum toxin in the treatment of chronic anal fissure as a primary mode of management, and to evaluate the results and clinical complications of botulinum toxin injection. In this study we used 40 units of botulinum toxin (DYSPORT)in 40 chronic anal fissure patients. The toxin was injected in two divided 20 unit doses in both sides of the anus (3 and 9 Oʹclock) intra-internal anal sphincter without anesthetics. The patients were followed two to eight weeks post-injection. None presented local complication (post injection pain, hematoma, or incontinence) Two thirds of the patients were symptom free, (70% had pain relief, and 77.5% had wound healing S weeks post botulinum toxin injection), and the rest had minor symptoms. Generally botulinum toxin injection is safe and, can reduce surgery costs and be used as a first line of treatment for chronic anal fissure especially in patients not fit for operation.