Frequency of complications in Dysport injection and Lateral internal Sphincterotomy in patients with anal fissure in Besat hospital (2003

Although lateral internal sphincterotomy is the procedure of choice for chronic anal fissures it is associated with significant complications. Injection of Botulinum toxin in the internal sphincter is a new treatment option with fewer side effects. This paper tries to compare these two approaches in terms of complications. In this cross sectional study، 50 patients with anal fissure who underwent lateral internal sphincterotomy in 1382 and 50 patients who were treated with Botulinum toxin، were evaluated. 20mg IV of Dysport was injected into the internal anal sphinter. Injection was repeated two weeks later if complete healing was not accomplished. Then the patients’ complications were evaluated within 12 months. In the sphincterotomy group the success rate was 84 percent (42/50) at 2 weeks and 94 percent (47/50) at the first month. Incontinence to flatus occurred in 16 percent and mild soiling was reported in 2 percent. Fistula occurred in 6 percent، and recurrence occurred in 8 patients. In the Botulinum Toxin group، single injection resulted in complete healing in 38 patients (76%). 12 patients were treated with a second injection، which resulted in an overall 90 percent Of healing. There were no complications and recurrence occurred in 11 patients. Injection of botulinum toxin is safe and effective in the treatment of anal fissure. No adverse effect resulted from injections of the toxin. We suggest two injections of Botulinum toxin as the first step in treatment of anal fissure. The patients who were not treated by injection of Botulinum toxin or had recurrence، underwent lateral Internal sphincterotomy.