Justin T Brady1, Alison R Althans2, Ruel Neupane3, Eslam M G Dosokey4, Murad A Jabir4, Harry L Reynolds3, Scott R Steele3, Sharon L Stein5. 1. Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Electronic address: Justin.Brady@UHhospitals.org. 2. Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. 3. Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. 4. Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Surgical Oncology, SECI, Assiut University, Assiut, Egypt. 5. Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Electronic address: Sharon.Stein@uhhospitals.org.
Abstract
BACKGROUND: Surgeons often approach anal fissure with chemical denervation (Botulinum toxin, BT) instead of initial lateral internal sphincterotomy (LIS) due to concerns for long-term incontinence. We evaluated the characteristics and outcomes of patients who received BT or LIS. METHODS: We performed a retrospective chart review of patients undergoing LIS and BT for anal fissure between 2009 and 2015. In 2015, a telephone survey was performed to evaluate durability, long-term incontinence and patient satisfaction. RESULTS: Ninety-four patients met criteria: 73 LIS and 21 BT. Age (BT 49 vs. LIS 52) was similar between groups (p = 1.0). Cleveland Clinic Fecal Incontinence (CCFI) score pre-intervention was higher in BT than LIS patients (2.1 vs. 0.4, p = 0.007) with fewer BT patients with perfect continence (50% vs. 88%). Telephone survey response was 61%. Fissure recurrence was significantly higher for BT than LIS patients (36% vs. 9%, p = 0.03). CONCLUSION: Patients undergoing LIS were less likely to recur. Both LIS and BT patients had some durable changes in continence raising the question of whether there is a safe technique.
BACKGROUND: Surgeons often approach anal fissure with chemical denervation (Botulinum toxin, BT) instead of initial lateral internal sphincterotomy (LIS) due to concerns for long-term incontinence. We evaluated the characteristics and outcomes of patients who received BT or LIS. METHODS: We performed a retrospective chart review of patients undergoing LIS and BT for anal fissure between 2009 and 2015. In 2015, a telephone survey was performed to evaluate durability, long-term incontinence and patient satisfaction. RESULTS: Ninety-four patients met criteria: 73 LIS and 21 BT. Age (BT 49 vs. LIS 52) was similar between groups (p = 1.0). Cleveland Clinic Fecal Incontinence (CCFI) score pre-intervention was higher in BT than LIS patients (2.1 vs. 0.4, p = 0.007) with fewer BTpatients with perfect continence (50% vs. 88%). Telephone survey response was 61%. Fissure recurrence was significantly higher for BT than LIS patients (36% vs. 9%, p = 0.03). CONCLUSION:Patients undergoing LIS were less likely to recur. Both LIS and BTpatients had some durable changes in continence raising the question of whether there is a safe technique.