Chronic anal fissure (CAF) is a common distressing problem with high recurrence rates. For many years, lateral internal sphincterotomy was the main treatment for CAF. Recently, intrasphincteric injection of botulinum toxin (BT) seems to be a good alternative option. The aim of this study was to evaluate the effectiveness and safety of BT type-A (botox) injection in the treatment of CAF. A total of 62 patients (45 males, 17 females; mean age of 41.3 years) with CAF who presented to surgical outpatient clinic at my hospital in the period between January 2014 and September 2015 were treated with BT injections of 20-30 units in the internal sphincter. They were followed up for one year to evaluate the effects of this treatment. The results of this study revealed that all patients had significant symptomatic relief with high rates of fissure healing reaching 74.2% (46 patients) after the first treatment session and 87.1% (54 patients) after the second session. During injections, no complications or side effects were reported. After injections, 19 patients experienced minor incontinence in the form of a fecal and gas soiling which solved spontaneously later. There were 3 relapses during 12 months of follow-up. I conclude that BT therapy can be considered effective, safe and without significant complication. It can be proposed to the patient as first line treatment before surgery.
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