In recent years treatment of chronic anal fissure has shifted from surgical to medical.
Dr Brisinda and colleagues compared the ability of 2 non-surgical treatments to induce healing in patients with idiopathic anal fissure.
The surgical treatments included botulinum toxin injections and nitroglycerin ointment.
The investigative team randomly assigned 100 adults.
The team randomized 50 patients who received type A botulinum toxin injected into the internal anal sphincter.
The other 50 patients received 0.2% nitroglycerin ointment applied 3 times daily for 8 weeks.
After 2 months, the fissures were healed in 92% of patients in the botulinum toxin group.
|Fissures were healed in 92% treated with botulinum toxin|
|British Journal of Surgery|
The investigators found that fissures healed in 70% of the nitroglycerin group.
The investigative team noted that 3 patients in the botulinum toxin group, and 17 in the nitroglycerin group reported adverse effects.
Those treated with botulinum toxin had mild incontinence to flatus that lasted 3 weeks after treatment but disappeared spontaneously.
In comparison, the team observed that nitroglycerin treatment was associated with transient, moderate-to-severe headaches.
The investigators reported that 19 patients who did not have a response to the assigned treatment crossed over to the other therapy.
Dr Brisinda's team commented, “Although treatment with either topical nitroglycerin or botulinum toxin is effective as an alternative to surgery for patients with chronic anal fissure, botulinum toxin is the more effective option.”