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A pilot comparative study of fissurectomy/diltiazem and fissurectomy/botulinum toxin in the treatment of chronic anal fissure

Arthur, J. ; Makin, C. ; El-Sayed, T. ; Walsh, C. ; Soll, C. ; Hahnloser, D.

In: Techniques in Coloproctology, 2008, vol. 12, no. 4, p. 331-336

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    Titre
    • A pilot comparative study of fissurectomy/diltiazem and fissurectomy/botulinum toxin in the treatment of chronic anal fissure
    Auteur
    • Arthur, J.. Wirral Colorectal Unit, Arrowe Park Hospital, Wirral, Merseyside, UK
    • Makin, C.. Wirral Colorectal Unit, Arrowe Park Hospital, Wirral, Merseyside, UK
    • El-Sayed, T.. Wirral Colorectal Unit, Arrowe Park Hospital, Wirral, Merseyside, UK
    • Walsh, C.. Wirral Colorectal Unit, Arrowe Park Hospital, Wirral, Merseyside, UK
    • Soll, C.. Department of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland
    • Hahnloser, D.. Department of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Techniques in Coloproctology, 2008, vol. 12, no. 4, p. 331-336. Springer Milan
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:322544
    Summary
    Background: Treatment of chronic anal fissure (CAF) by fissurectomy with botulinum toxin A (BTA) injection results in a healing rate of greater than 90%. BTA injection, however, can cause incontinence and perianal sepsis. The decrease in sphincter pressure following topical treatment with 2% diltiazem cream (DTC) is comparable to that following BTA injection but with potentially fewer complications and at less cost. We report the shortterm results of a pilot study comparing fissurectomy with BTA and fissurectomy followed by DTC for the treatment of CAF. Methods: The recorded outcomes of CAF following treatment with the two methods were analysed retrospectively. Patients underwent either fissurectomy followed by injection of 40 U BTA into the internal sphincter (group A) or fissurectomy followed by the perianal application of DTC twice daily for 8 weeks (group B). Symptom resolution and treatment side effects at the initial follow-up were compared. Results: Demographics, fissure characteristics and the number of multiparous women between the two groups were comparable. At a median follow-up of 12 weeks (range 8-20 weeks), the two groups had similar rates of complete symptom resolution (group A, 25/28, 89.3%; group B, 19/23, 82.6%; p=0.7739), with minor side effects. Conclusions: In this small pilot study fissurectomy combined with chemical sphincterotomy resulted in high short-term fissure healing rates. The study also suggested that fissurectomy followed by 8 weeks of topical DTC may be as good as fissurectomy with BTA injection in the treatment of CAF. A prospective study, adequately powered to determine the significance of differences is needed