A team from Valencia, Spain analyzed the long-term outcome of patients in whom an anal fissure had healed after botulinum toxin injection.
They also assessed factors contributing to recurrence of the fissure.
A total of 57 patients, who had completely healed 6 months after injection of botulinum toxin, were included in the study and reassessed every 6 months.
The follow-up was 42 months in all patients.
Clinical and manometric differences between the permanently healed and the relapsed group were analyzed.
| Anal fissure recurred in 42% of patients.
| Gastroenterology |
Of the patients, 4 were lost to follow-up.
A fissure recurred in 42% of the patients.
Statistical differences between the permanently healed and the relapsed group were detected.
The authors noted that anterior location of the fissure was more common in the relapsed group (6% vs 45%).
Other indicators of relapse included a longer duration of the disease (38% vs 68%), the need for reinjection (26% vs 59%), and a higher total dose injected to achieve definitive healing (13% vs 45%).
The percentage decrease of maximum squeeze pressure after injection (-28% vs -13%) was also lower in the relapse group.
Dr Miguel Minguez, of the University of Valencia, said on behalf of the group, "The late recurrence rate of chronic anal fissure is high when the effect of botulinum toxin disappears."
"The highest risk of recurrence is associated with anterior location of the anal fissure, prolonged illness, the need for reinjection and for high doses to achieve healing, and a lower decrease of maximum squeeze pressure after treatment," it was concluded.