Combination of Botulinum Toxin and Topical Diltiazem Versus Lateral Sphincterotomy in Treatment of Chronic Anal Fissure

Abstract

Introduction: Chronic anal fissure (CAF) is a common anorectal condition with treatment modalities being introduced to avoid the complications of surgical intervention. Aims & Objectives: To compare LIS versus combination of botulinum toxin injection and topical diltiazem in terms of frequency of healing in patients with chronic anal fissure. The outcome was measured frequency of healing of CAF within four weeks after treatment. Study design was randomized controlled trial (RCT) Place and duration of study: The place was Surgical Department, Chaudhry Mohammad Akram Lahore. And duration of study is 6 months (1st Jan 2022 to 31stJune 2022) Material & Methods: Total 100 patients were enrolled and randomly allocated into two groups A& B (50 in each group). In Group A patients LIS (open technique) was performed. While in group B, patients were administered, 20 U of botulinum toxin A diluted in 2 ml normal saline was injected via 27 G insulin needle into the internal sphincter around the fissure area. Furthermore, diltiazem paste was applied twice daily up to two weeks. All patients were assessed for healing of the fissure weekly up to four weeks. Data was analyzed using SPSS version-24, P-value<0.05 was taken as significant Results: Out of 100 patients, 82 (82%) patients showed complete healing within four weeks of treatment. The healing within four weeks was 94% in group A and 70% in group B (p value 0.002). Conclusion: The frequency of healing of CAF by LIS is significantly higher than the combination of botulinum toxin plus topical diltiazem. The results can be applied after satisfactory confirmation from the larger RCTs.

Keywords

• Botulinum toxin, chronic anal fissure CAF, Chemical sphincterotomy Diltiazem ointment, Lateral internal sphincterotomy (LIS)