Abstracts
2002 Digestive Disease Week

# 102496 Abstract ID: 102496 Comparison of Botulinum Toxin Injection and Lateral Internal Sphincterotomy in the Treatment of Chronic Anal Fissure
Adnan Giral, Yücel Gültekin, Kemal Memisoglu, Teoman Parmaksizoglu, Nese Imeryuz, Osman Ozdogan, Cem Kalayci, Nurdan Tozun, Nefise B Ulusoy, Istanbul, Turkey

Lateral internal sphincterotomy (LIS) is the standart treatment for chronic anal fissure (CAF) and is associated with a risk of anal incontinence. Intrasphincteric injection of Botulinum toxin (BT) is a reliable new option in the treatment of CAF. We aimed to compare the efficacy of BT injection treatment with that of LIS regarding anal sphincter pressures and CAF healing rates. Patients and Methods: Thirty patients with CAF of at least 2 months duration who did not respond to medical therapy were enrolled. After a detailed explanation, patients chose one of the two treatment modalities. Ten units of BT (Botox, Allergan, Ireland) was injected into the internal anal sphincter on both sides of the fissure using 28 G needle (total dose 20 U). Anal manometry measurements were performed before and 2 week after treatments. Basal Maximal Resting Pressure (BMRP) and Maximal Squeeze Pressure (MSP) were measured using a water perfused catheter with 8 holes 0.5 cm apart. BMRP was defined as the average of maximal pressures obtained from all holes by stationary pull-through technique. MSP was defined as the difference between the mean pressure obtained voluntary squeezing of 30 sec and resting pressure when all of the holes were within the anal canal. Mean of the two consecutive MSP was used for analysis. CAF healing was evaluated at 3rd month by inspection and patients were followed for 6 months. Results were expressed as mean?SD. Results: Twenty patients (F/M:7/13, age:36?11) and ten patients (F/M:4/6, age:41?11) respectively underwent LIS and BT injection treatment. CAF healing rates for LIS and BT injection were respectively 75% and 70% (p>0.05). There was no complication in the BT group, but one temporary flatus incontinence and one perianal abscess were observed in LIS group. No relapse was observed during follow up period. Conclusion: Reduction in anal sphincter pressures and chronic anal fissure healing rates were comparable in lateral internal sphincterotomy and Botulinum toxin injection treatment in short term.