Comparison of Different Doses Botulinum Toxin Type a Efficacy in Chronic Anal Fissure Treatment

Abstract

Abstract Objective: To compare the results of chronic anal fissure treatment with 10 IU and 40 IU botulinum toxin type A. Patients and methods: 56 patients were enrolled in case-control study divided into 2 groups consistent by the main clinical criteria. 28 patients in the study group had fissure excision in combination with 10 IU botulinum toxin type A (Xeomin) injection into internal anal sphincter, while 28 patients in control group received 40 IU product injections. Results: No statistically significant results in the pain assessment during the day and after bowel movement were obtained (p=0.41 and p=0.93, respectively). The groups were comparable by the frequency of complications such as transient anal incontinence, perianal skin hematoma, acute urinary retention (p>0.05). Complications such as thrombosis of external hemorrhoids and chronic non-healing wounds were most common in the study group (p=0.43 and p=0.0005, respectively). The product dose increase to 40 IU has a more significant effect on the functional treatment results (p=0.0053 and p=0.0002, respectively) and increases the odds for postoperative wound epithelialization 15-fold (p=0.01). Conclusion: 40 IU Botulinum toxin type A shows improvement in the treatment of chronic anal fissure without any increased risk of postoperative complications.