Our View on Fissure Healing Should Be Verified

Excerpt

To the Editor—The study by Thornton et al.1 on reduction of the anal sphincter pressure after botulinum toxin (BT) treatment for chronic anal fissure (CAF) offers interesting insights into fissure healing. The authors found no correlation between clinical outcome (fissure healing or deterioration in continence) or subsequent reduction in maximum anal resting pressure, although maximum anal resting pressure decreased by 17 percent. Similarly, Ho and Ho2 reported that fissure healing did not seem to be dependent on a reduction in mean anal resting pressure. These data, as well as the fact that fissures associated with normal anal pressures heal after lateral internal sphincterotomy,3,4 suggest that factors other than simple reduction in sphincter tone are responsible for fissure healing. …