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Botulinum toxin therapy for chronic anal fissures: where are we at currently?
Author(s) -
Dat Anthony,
Chin Martin,
Skinner Stewart,
Farmer Chip,
Wale Roger,
Carne Peter,
Bell Stephen,
Warrier Satish K.
Publication year - 2017
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13329
Subject(s) - medicine , odds ratio , botulinum toxin , confidence interval , logistic regression , surgery , retrospective cohort study , audit , management , economics
Background Botulinum toxin ( B otox) injection for chronic anal fissure ( CAF ) is commonly performed, yet there remains no consensus on optimal dosage or frequency of injections required to achieve complete resolution of anal fissure. The aim of this study was to determine the effectiveness of Botox and side‐effect profile in the management of CAF . Methods A retrospective clinical study of patients between 2010 and 2014 who underwent a B otox injection for CAF at a tertiary centre was performed. The effectiveness of B otox was measured using standardized outcomes including overall healing rate, presence of anal pain, recurrence and need for repeat botulinum injection. Binary outcomes were assessed using logistic regression model. The analysis was performed using S tata version 13 ( S tata C orp, C ollege S tation, TX , USA). Results One hundred and one patients underwent 126 B otox injections within the study period. The mean first post‐operative visit was at 1 month. The overall recurrence rate was 32%. The majority of patients were given 33 U. No statistically significant relationship between dose and recurrence was identified. The presence of pain at the first post‐operative visit was a predictor of future recurrence (odds ratio 3.92, confidence interval 1.58–9.74, P = 0.003). Conclusion Botox is an effective strategy for CAF. Low doses can be given with good efficacy as highlighted by our audit and has the potential for great cost saving. The best predictor of recurrence is the presence of pain at the first post‐procedure visit.