Botulinum toxin injections vs lateral internal sphincterotomy in chronic anal fissure management

Abstract

Among the various treatment modalities for chronic anal fissures, lateral internal sphincterotomy, acknowledged as the gold standard, is associated with superior healing rates but entails a higher risk of complications due to its invasive nature. Conversely, botulinum toxin injection, a minimally invasive alternative, remains a viable therapeutic option for select patient populations despite its relatively higher recurrence rate, owing to its favorable safety profile. The objective of this study was to compare the botulinum toxin and sphincterotomy efficacy in the management of chronic anal fissure. Two groups were compared in treatment outcomes after botulinum toxin injection and lateral internal sphincterotomy. The study cohort comprised women diagnosed with chronic anal fissure and treated between 2017 and 2022. Patients underwent botulinum toxin injections and partial sphincterotomy. Clinical outcomes and examination findings were assessed to determine the therapeutic efficacy of botulinum toxin infiltration in comparison to surgical intervention. An increased recurrence rate was noted in patients with a prolonged disease course and posteriorly located fissures. Botulinum toxin may serve as a first-line therapeutic strategy in individuals with a low predisposition to recurrence, offering an effective and safer alternative in appropriately selected cases.