Outcome of botulinum toxin with lateral internal sphincterotomy for treatment of chronic anal fissure

Background: therapies that reduce anal sphincter pressures have been used to achieve fissure healing. lateral internal sphincterotomy (lis) is the most common treatment for caf and can be effective in more than 90 percent of cases but needs general or local anesthesia. aim: to compare the outcome of botulinum toxin with lateral internal sphincterotomy for treatment of chronic anal fissure. methods: this randomized control trials was conducted at department of surgery,jinah hospital lahore. using nonprobability purposive sampling study was completed in six months. patients were divided into two groups. informed and written consent was taken. fifty patients in group a received treatment with botulinum toxin (0.5cc of injection neuronox injected in the sphincters under direct vision and digital examination) and fifty patients in group b with internal sphincterotomy (distal internal sphincters was incised surgically with electrocoagulation). patients were discharged next day from hospital and follow up was done after two weeks. at follow up,patients were evaluated for fecal incontinence (yes or no),healing (yes or no) and recurrence (yes or no). results: in our study,age and gender were insignificantly different while comparison of recurrence of anal fissure in both groups show 10(20%) in groupa and 2(4%) were in groupb while 40(80%) in groupa and 48(96%) in groupb had no recurrence,p value was computed as 0.02,19(38%) in groupa and 43(86%) were in groupb while 31(62%) in groupa and 7(14%) in groupb could not heal,p value was 0.000,while fecal incontinence of anal fissure in both groups was compared and it shows 3(6%) in groupa and 5(10%) in groupb had fecal incontinence while 47(94%) in groupa and 45(90%) in groupb had no fecal incontinence,p value=0.71. conclusion: comparison of the outcome of botulinum toxin with lateral internal sphincterotomy for treatment of chronic anal fissure concludes that lateral internal sphincterotomy is significantly better and may be offered in our patients in future.