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Open Access 01-07-2018 | Original Article

Bilateral versus unilateral botulinum toxin injections for chronic anal fissure: a randomised trial

Authors: S. A. Pilkington, R. Bhome, R. E. Welch, F. Ku, C. Warden, S. Harris, J. Hicks, C. Richardson, T. C. Dudding, J. S. Knight, A. T. King, A. H. Mirnezami, N. E. Beck, P. H. Nichols, K. P. Nugent

Published in: Techniques in Coloproctology | Issue 7/2018

Abstract

Background

Botulinum toxin injected into the internal anal sphincter is used in the treatment of chronic anal fissure but there is no standardised technique for its administration. This randomised single centre trial compares bilateral (either side of fissure) to unilateral injection.

Methods

Participants were randomised to receive bilateral (50 + 50 units) or unilateral (100 units) Dysport^® injections into the internal anal sphincter in an outpatient setting. Injection-related pain assessed by visual analogue scale was the primary outcome measure. Secondary outcomes were healing rate, fissure pain, incontinence, and global health scores.

Results

Between October 2008 and April 2012, 100 patients with chronic anal fissure were randomised to receive bilateral or unilateral injections. Injection-related pain was comparable in both groups. There was no difference in healing rate. Initially, there was greater improvement in fissure pain in the bilateral group but at 1 year the unilateral group showed greater improvement. Cleveland Clinic Incontinence score was lower in the unilateral group in the early post-treatment period and global health assessment (EuroQol EQ-VAS) was higher in the unilateral group at 1 year.

Conclusions

Injection-related pain was similar in bilateral and unilateral injection groups. Unilateral injection was as effective as bilateral injections in healing and improving fissure pain without any deterioration in continence.

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Title: Bilateral versus unilateral botulinum toxin injections for chronic anal fissure: a randomised trial
Authors: S. A. Pilkington
R. Bhome
R. E. Welch
F. Ku
C. Warden
S. Harris
J. Hicks
C. Richardson
T. C. Dudding
J. S. Knight
A. T. King
A. H. Mirnezami
N. E. Beck
P. H. Nichols
K. P. Nugent
Publication date: 01-07-2018
Publisher: Springer International Publishing
Published in: Techniques in Coloproctology / Issue 7/2018
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-018-1821-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Bilateral versus unilateral botulinum toxin injections for chronic anal fissure: a randomised trial

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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