P Ravindran1,2, D L Chan3,4, C Ciampa1,2, R George1, G Punch1, S I White1,2,5. 1. Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, 2485, Australia. 2. Faculty of Medicine, Bond University, Robina, QLD, Australia. 3. Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, 2485, Australia. daniel.l.chan@unsw.edu.au. 4. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. daniel.l.chan@unsw.edu.au. 5. John Flynn Colorectal Centre, Tugun, QLD, Australia.
Abstract
BACKGROUND: There is no consensus on the optimal dosage of botulinum toxin (BT) as a sphincter sparing alternative to lateral internal sphincterotomy for chronic anal fissure. The aim of this study was to assess the long-term efficacy of high-dose BT as well as the presence of incontinence following the treatment of chronic anal fissure at a single institution. METHODS: A retrospective case-control study was performed at a single institution over a 6-year period (2009-2014). Patients given high-dose (80-100 IU) BT were compared to low-dose (20-40 IU) case controls. Clinical notes were reviewed, and follow-up was carried out via a telephone questionnaire. RESULTS: One hundred and fifty-eight patients were treated with BT injections within the study period (103 high dose; 55 low dose). The mean length of follow-up was 25 months (range 4-52 months). Classic posterior fissures with high anal tone were more prevalent in the low-dose group (40 vs 47%, p = 0.3). Patient satisfaction was higher in the high-dose group (90 vs 78%, p = 0.05). Long-term recurrence (6 months after the last treatment) was also lower (23 vs 53%, p = 0.0001) on multivariate analysis. No long-term incontinence was observed. CONCLUSIONS: In this series, the recurrence rate post-BT injection was significantly lower in the high-dose group. There was no long-term incontinence. Further studies are needed to confirm our results.
BACKGROUND: There is no consensus on the optimal dosage of botulinum toxin (BT) as a sphincter sparing alternative to lateral internal sphincterotomy for chronic anal fissure. The aim of this study was to assess the long-term efficacy of high-dose BT as well as the presence of incontinence following the treatment of chronic anal fissure at a single institution. METHODS: A retrospective case-control study was performed at a single institution over a 6-year period (2009-2014). Patients given high-dose (80-100 IU) BT were compared to low-dose (20-40 IU) case controls. Clinical notes were reviewed, and follow-up was carried out via a telephone questionnaire. RESULTS: One hundred and fifty-eight patients were treated with BT injections within the study period (103 high dose; 55 low dose). The mean length of follow-up was 25 months (range 4-52 months). Classic posterior fissures with high anal tone were more prevalent in the low-dose group (40 vs 47%, p = 0.3). Patient satisfaction was higher in the high-dose group (90 vs 78%, p = 0.05). Long-term recurrence (6 months after the last treatment) was also lower (23 vs 53%, p = 0.0001) on multivariate analysis. No long-term incontinence was observed. CONCLUSIONS: In this series, the recurrence rate post-BT injection was significantly lower in the high-dose group. There was no long-term incontinence. Further studies are needed to confirm our results.
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