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High-dose versus low-dose botulinum toxin in anal fissure disease

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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.

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Authors and Affiliations

  1. Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, 2485, Australia

    P. Ravindran, D. L. Chan, C. Ciampa, R. George, G. Punch & S. I. White

  2. Faculty of Medicine, Bond University, Robina, QLD, Australia

    P. Ravindran, C. Ciampa & S. I. White

  3. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia

    D. L. Chan

  4. John Flynn Colorectal Centre, Tugun, QLD, Australia

    S. I. White

Authors
  1. P. Ravindran
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  2. D. L. Chan
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  3. C. Ciampa
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  4. R. George
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  5. G. Punch
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  6. S. I. White
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Corresponding author

Correspondence to D. L. Chan.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was in accordance with the ethical standards of the institutional research committee, Greenslopes Research and Ethics Committee, Protocol 13/31, and with the 1964 Helsinki declaration.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

This paper is based on oral presentation accepted at the 2017 International Surgical Congress of the Association of Surgeons of Great Britain and Ireland, Glasgow, UK and oral presentation at the 2016 Royal Australasian College of Surgeons—Annual Scientific Conference, Brisbane, Australia.

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Ravindran, P., Chan, D.L., Ciampa, C. et al. High-dose versus low-dose botulinum toxin in anal fissure disease. Tech Coloproctol 21, 803–808 (2017). https://doi.org/10.1007/s10151-017-1700-2

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  • DOI: https://doi.org/10.1007/s10151-017-1700-2

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