Affiliation:
1. Prince Charles Hospital
2. National Hepatology and Tropical Medicine Research Institute
3. Royal Glamorgan Hospital
Abstract
Abstract
Background: Perianal fissure is one of the most painful anal conditions. Various management options are available, including topical nitrites, calcium channel blockers, botulinum toxin injection, and sphincterotomy.Aim: To assess the efficacy and safety of Botulinum Toxin A (BT) injection in the management of symptomatic chronic anal fissure by conducting a systematic review of literature and meta-analysis of published Randomised Controlled Trials (RCTs)Methodology: Systematic search conducted using Embase and Medline search platforms, extending from January 1974 to September 2020. The search identified 264 published papers, of which 35 RCTs were identified. Meta-analysis was performed on the collected data with a random effects model using the Freeman-Tukey arcsine transformed proportions. A p-value less than 0.05 was deemed significant. The I2 test was used to test for heterogeneity.Results: A total of 1532 patients were included. Upon pooling of the data, 1117 patients out of 1532 (72.7%) demonstrated healing of the fissure after the first injection with BT (P < 0.001, I2 = 86.6%). Subgroup analysis was done based on the follow-up period in months. 9 studies reported that a second BT injection was needed in patients who did not respond after the initial injection. 29 out of 38 patients (78.5%) showed a response to the second injection (p < 0.001, I2 = 50.6%). Complications were observed in 88 out of 1532 patients (4.02%) with p < 0.001, I2 = 60.2%.Conclusion: BT injection for chronic symptomatic anal fissures is effective and safe with minor temporary complications. There is evidence to support offering a repeat injection for recurrent/ persistent symptoms.
Publisher
Research Square Platform LLC
Reference47 articles.
1. Kodner IJ, Fry RD, Fleshman JW, Birnbaum EH, Read TE. Colon, Rectum, and Anus. In: Schwartz Seymour I, et al., editors. Principles of Surgery. 7th ed. Mac Grow-Hill: 1999. pp. 1265–1382. PMID: 17604520
2. The pharmacology of the internal anal sphincter and new treatments of anorectal disorders;Cook TA;Aliment Pharmacol Ther,2001
3. Beck DE, Timmcke AE. Pruritus ani and fissure-in-ano. In: Beck DE, editor. Handbook of Colorectal Surgery. 2nd ed. New York: Marcel Dekker; 2003. p. 367.
4. Aetiology and treatment of anal fissure;Lund JN;Br J Surg,1996
5. Sustained internal sphincter hypertonia in patients with chronic anal fissure;Farouk R;Dis Colon Rectum,1994