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

Techniques in Coloproctology
S A PilkingtonK P Nugent

Abstract

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. 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. 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. Injection-related pain was similar in bilater...Continue Reading

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Citations

Jul 12, 2020·American Journal of Clinical Dermatology·Tina S Alster, Iris S Harrison
Sep 18, 2021·World Journal of Emergency Surgery : WJES·Antonio TarasconiFausto Catena
Oct 8, 2021·The American Journal of Gastroenterology·Arnold WaldMassarat Zutshi

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