COMPARING THE EFFICACY OF BOTULINUM TOXIN INJECTION AND LATERAL INTERNAL SPHINCTEROTOMY FOR CHRONIC ANAL FISSURE

Objective: The objective of this study is to: “compare the effectiveness of Botulinum toxin injection with lateral internal
sphincterotomy for the treatment of chronic anal fissure in terms of healing”.
Material and Methods: Informed written consent was taken from patients and ethical approval was taken from the
Institutional Research and Ethical Board (IREB).All patients fulfilling inclusion criteria were included in the study. Patients
in group ‘A’ were treated with 0.5 ml (20 units) of Botulinum toxin injection in the internal anal sphincters under direct
vision and digital examination at 3 or 9 o’clock position at lithotomy position under strict aseptic measures. Patients
were sent home after one hour with stool softeners. Patients in group ‘B’ underwent lateral internal sphincterotomy
under general anesthesia. In both groups, patients were followed after 2 months. At follow up, patients were examined
for healing (yes or no) to determine intervention effectiveness.
Results: A total of 396 patients of chronic anal fissure were included in the study, which were divided into two equal
groups. Efficacy was significant in both the procedure with p-value=0.045.
Conclusion: Botulinum toxin injection is more effective than lateral internal sphincterotomy in the management of
chronic anal fissure.
Key Words: Botulinum toxin, lateral internal sphincterotomy, chronic anal fissure, healing