[Favourable results with local injections of botulinum-A toxin in patients with chronic isosorbide dinitrate ointment-resistant anal fissures].

OBJECTIVE

To determine the effectiveness of injection of botulinum-A toxin in the internal anal sphincter as a treatment for chronic therapy-resistant anal fissures.

DESIGN

Prospective.

METHODS

In the period October 2002-February 2005, 32 consecutive patients (15 men and 17 women), with a median age of 44 years (range: 23-78 years) and suffering from chronic isosorbide dinitrate ointment-resistant anal fissures, were treated with an injection of 40 IU botulinum-A toxin (Dysport, Ipsen, The Netherlands) in the ventral side of the internal anal sphincter. The injection was given as an outpatient procedure under general or spinal anaesthesia.

RESULTS

After a median follow-up of 14 months (range: 2-28 months), the chronic anal fissures were cured in 24 ofthe 32 patients (75%). Twenty-two patients were given a second or a third injection. A fissure recurred in one of the cured patients (4%), and one patient suffered from temporary flatus incontinence.

CONCLUSION

Botulinum-A toxin injections were effective in 75% of patients with isosorbide dinitrate ointment-resistant chronic anal fissures. This is a simple technique with fewer side effects than local application of NO donors and fewer complications and less morbidity than surgical sphincterotomy.