Is Botox an Alternative to Surgery for Anal Fissure?

Abstract

Objective To compare the results of the lateral internal sphincterotomy(LIS) technique and high dose botulinum toxin, which is one of the treatments applied when medical treatment is insufficient in anal fissure. Materials and methods The files and outpatient clinic notes of the patients who underwent lateral internal sphincterotomy and botulinum toxin injection due to lack of response to medical treatment due to anal fissure between May 2020 and May 2023 were examined retrospectively. Preoperative and postoperative visual analog scale (VAS) scores, five-point horizontal scale (FPHS) scores, hospitalization times, fissure locations, follow-up periods, anesthesia type, and postoperative complications of the patients were recorded. Results Total 30 LIS and 24 botulinum toxin-treated patients were included. Hospitalization time was shorter in botulinum toxin groups than in the LIS group (p<0.001). First-week VAS score was lower than botulinum toxin injection group (p<0.001). There was no significant difference between the groups in terms of FPHS scores, follow-up periods, and recurrence (p:0.15, p:0.07, p:0.14). Conclusion: While LIS is faster in the early period, botulinum toxin injection can be considered as an alternative to surgical treatment for long-term results.