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Dokcu Ş, Başçeken Sİ. Botulinum toxin injection in outpatients for chronic anal fissure. Acta Chir Belg 2024; 124:131-136. [PMID: 37440688 DOI: 10.1080/00015458.2023.2234179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES The aim of the study was to evaluate the effect of botulinum toxin (BT) injection on fissure healing in the treatment of chronic anal fissure (CAF) in outpatient conditions without any analgesia and sedation to the internal anal sphincter (IAS). The primary outcome measure was post-procedural pain. The secondary outcome measures were fissure healing and complications. METHODS Prospectively preserved data of 67 patients who received BT injections for CAF were analyzed prospectively. Demographic data, duration of symptomatic improvement, fissure location and number, parity, post-procedural pain, complications, continence status, response to treatment, and duration of follow-up were examined. Participants received bilateral (50 + 50 units) BT injections into the internal anal sphincter (IAS) in an outpatient setting. RESULTS Symptomatic improvement was observed in 58% of patients within 1 week. The complete response rate to treatment was 82% at a mean follow-up of 6 months. Patients with partial response to treatment (10%) were successfully treated with topical therapy, and patients with persisting fissures (8%) were successfully treated with partial lateral internal sphincterotomy (LIS). 14 patients (21%) reported some degree of transient incontinence at follow-up. Multiparous women experienced more symptoms of Incontinence (p = 0.00). Pre- and post-procedural Vas Score median values were 4. The 7th-week VAS score median value was 3. CONCLUSION Dysport injection under sedation-free outpatient conditions is an effective and safe alternative to LIS for the treatment of CAF, with tolerable procedural pain. All patients should be warned of transient incontinence.
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Affiliation(s)
- Şeref Dokcu
- Gazi Yaşargil Training and Research Hospital Surgical Oncology Department, Health Sciences University, Kayapınar Diyarbakır, Turkey
| | - Salim İlksen Başçeken
- Gazi Yaşargil Training and Research Hospital Surgical Oncology Department, Health Sciences University, Kayapınar Diyarbakır, Turkey
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Peeroo S, Rajagopalan A, Arachchi A, Penfold S, Roschach B, Nguyen TC, Teoh W. Outcomes Following Intrasphincteric Injection of Botulinum Toxin for Treatment of Anal Fissures. Cureus 2024; 16:e53668. [PMID: 38327720 PMCID: PMC10847891 DOI: 10.7759/cureus.53668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 02/09/2024] Open
Abstract
Background Intrasphincteric injection of botulinum toxin is an alternative treatment for anal fissures, which may present less risk of fecal incontinence than more invasive procedures, such as lateral internal sphincterotomy. The aim is to compare cure and complication rates between these two treatments. Methods We conducted a retrospective audit of patients who underwent treatment of anal fissures with intrasphincteric botulinum toxin or lateral internal sphincterotomy from 2016 to 2020 at the Colorectal Surgery Unit of Monash Health, Melbourne, Australia, excluding those who had previously had either procedure. Results Fifty-one patients received intrasphincteric botulinum toxin, and 40 patients underwent lateral internal sphincterotomy. Most patients in the botulinum group had a total dose of either 80 (53%; n=27) or 100 units (37%; n=19) and had the dose administered bilaterally at the 3 o'clock and 9 o'clock positions (n=41; 80%). Thirty-one patients in the botulinum group (61%) had complete resolution of symptoms, with a mean time to cure of two months, compared to 36 patients (90%) in the sphincterotomy group with a mean time to cure of 1.5 months. In most cases, postoperative incontinence was transient, although one patient in the botulinum group had persistent incontinence of flatus, and two patients in the sphincterotomy group had persistent fecal incontinence. Conclusion Intrasphincteric botulinum injection is an effective, less-invasive alternative to sphincterotomy for the treatment of anal fissures, with incontinence usually temporary when it occurs. Further research is needed to optimize the dose and location of injection and guide future recommendations.
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Affiliation(s)
- Saania Peeroo
- Department of Surgery, Monash Health, Melbourne, AUS
| | | | | | - Samuel Penfold
- Department of Surgery, Monash University, Melbourne, AUS
| | | | | | - William Teoh
- Department of Surgery, Monash Health, Melbourne, AUS
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Burtic SR, Castiglione L, Murariu M, Rosca O, Dumitru C, Neagoe O. Assessment of Quality of Life in Patients with Chronic Anal Fissures: A 1-Year Follow-Up Study before and after Botulinum Toxin (Botox) Injection. J Clin Med 2024; 13:316. [PMID: 38256449 PMCID: PMC10816032 DOI: 10.3390/jcm13020316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
This longitudinal study aimed to assess the quality of life in patients with anal fissures treated with botulinum toxin (Botox) injections over a one-year period. The study hypothesized that Botox injections would significantly improve quality of life and that these improvements would be sustained over a year. Conducted as a cross-sectional study, it assessed adults diagnosed with chronic anal fissures unresponsive to conventional treatments. Participants received 25 U of Botox in two sessions and their quality of life was assessed using the WHOQOL-BREF, COPE-60, Hospital Anxiety and Depression Scale (HADS), and SF-36 surveys. Data were collected at baseline six months and one year post-treatment. The study involved 113 patients, with a mean age of 38.1 years. Significant improvements were observed in the WHOQOL-BREF scores across all domains from baseline to 12 months (physical domain: 49.4 ± 10.5 to 70.2 ± 10.6, p < 0.001; mental domain: 34.8 ± 11.2 to 61.9 ± 11.5, p < 0.001). SF-36 scores also showed significant enhancements in physical and mental health components (physical: 44.3 ± 7.5 to 56.9 ± 5.9, p < 0.001; mental: 41.1 ± 7.2 to 54.4 ± 6.3, p < 0.001). Additionally, significant improvements were noted in patient perception on quality of life from the perspective of various aspects including physical discomfort, pain management, and mood and emotional well-being. The study demonstrated that Botox injections significantly improved the quality of life in patients with chronic anal fissures, with sustained benefits observed over a year. These findings suggest Botox as an effective treatment modality for enhancing life quality in patients with this condition, highlighting the potential for broader applications in managing chronic anal fissures.
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Affiliation(s)
- Sonia-Roxana Burtic
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Department II, Discipline of Medical Communication, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Luca Castiglione
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Marius Murariu
- Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Ovidiu Rosca
- Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Catalin Dumitru
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Octavian Neagoe
- Second Discipline of Surgical Semiology, First Department of Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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Karcioglu O, Akman C, Atnis I. Efficacy and Safety Analysis of Botox Application and Iatrogenic Botulism: Panacea or Peril? Curr Pharm Des 2024; 30:578-588. [PMID: 38409723 DOI: 10.2174/0113816128284720240212111926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/24/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024]
Abstract
Clostridium botulinum toxin-A (BoNT-A) creates temporary paralysis in the muscles by acting on the muscle-nerve junction. It is injected into the mimic muscles when a decrease in the movements of the mimic muscles is desired. Despite many favorable applications, the use of BoNT-A is not without drawbacks. Although there is no expected serious side effect on health in BoNT-A treatments, various problems can be encountered in patients treated for aesthetic purposes. Botulism is a rare but potentially life-threatening syndrome, which is caused by the toxin produced by the bacterium Clostridium botulinum, which acts on the nervous system, vegetative forms of C. botulinum can only survive in anaerobic conditions, while spore forms are common in nature and can withstand harsh conditions. Botulism can stem from bacterial spores which release toxin in the body; in the form of enteric botulism, and wound botulism. The cases that develop 'iatrogenic botulism' after such procedures are usually those receiving high-dose toxin for therapeutic purposes. The treatment of botulism mainly consists of anti-toxin therapy and, if necessary, intensive care to prevent organ failures, including respiratory support. This article aims to cover all these issues related to botulism and other adverse outcomes related to BoNT-A injection in light of the most recent literature.
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Affiliation(s)
- Ozgur Karcioglu
- Department of Emergency Medicine, Taksim Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Canan Akman
- Department of Emergency Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ilknur Atnis
- Department of Emergency Medicine, Niğde Omer Halisdemir Education and Research Hospital, University of Health Sciences, Nigde, Turkey
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Shahid MH, Javed S, Javed S, Khan AZ, Kaiser A, Mithany RH. Comparative Efficacy of Topical Metronidazole and Glyceryl Trinitrate Versus Topical Glyceryl Trinitrate Alone in the Treatment of Acute Anal Fissure: A Randomized Clinical Trial. Cureus 2022; 14:e31812. [DOI: 10.7759/cureus.31812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 11/24/2022] Open
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Li W, Xu J, Li T, Bi Y, Ren W, Wei S. Efficacy of posterior median anal incision with incision and drainage of the anal sinus on chronic anal fissure. Am J Transl Res 2022; 14:432-439. [PMID: 35173862 PMCID: PMC8829648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND To explore the efficacy of posterior median anal incision plus incision and drainage of anal sinus on chronic anal fissure (CAF), and its influence on incidence and recurrence of postoperative infection. METHODS Altogether 130 patients with CAF treated during January 2017 and January 2021 were included and divided into a research group (RG) and control group (CG). Among them, 80 patients in the RG were treated with posterior median anal incision and expansion plus anal sinus incision and drainage, while 50 in the CG were treated with lateral internal sphincterotomy. Clinical indexes (wound healing time, recovery time of bowel sounds, intraoperative blood loss, length of stay), levels of inflammatory factors (IL-6, IL-8, CRP) before and one week after treatment, changes of psychological and emotional scores (SAS, SDS scores) before and 6 months after treatment, sleep and scores of daily activities after admission and 6 months after treatment, VAS scores at 1 day, 1 week and 2 weeks after operation, compliance, total effective rate, and incidence and recurrence rate of postoperative incision infection were compared between the groups. RESULTS Compared with the CG, the wound healing time, recovery time of bowel sounds and length of stay were shorter, and intraoperative blood loss was lower in the RG; the levels of IL-6, IL-8 and CRP were lower in RG one week after treatment. Six months after treatment, the SAS, SDS and PSQI scores were lower, the ADL scores were higher, the compliance and total effective rate were higher, and the incidence and recurrence rate of postoperative incision infection were lower in the RG. CONCLUSION Posterior median anal incision plus incision drainage of the anal sinus has better efficacy on CAF, and can effectively reduce the incidence of postoperative infection and recurrence.
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Affiliation(s)
- Wei Li
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
| | - Jiacheng Xu
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
| | - Tao Li
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
| | - Yuhe Bi
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
| | - Weicai Ren
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
| | - Shengchao Wei
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
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Perivoliotis K, Baloyiannis I, Ragias D, Beis N, Papageorgouli D, Xydias E, Tepetes K. The role of percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic anal fissure: a systematic review. Int J Colorectal Dis 2021; 36:2337-2346. [PMID: 34132862 DOI: 10.1007/s00384-021-03976-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE This study was designed to summarize the current evidence regarding the role of percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic anal fissure (CAF). METHODS The present systematic review of the literature was conducted on the basis of the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The primary endpoint of our study was the CAF recurrence rate. Quality assessment was based on the RoB 2 tool and the Case Series Quality Checklist. RESULTS Overall, 5 studies and 102 patients were included. A considerably heterogeneity in the neuromodulation technique and setting was identified. The pooled recurrence rate was estimated at the level of 19% (16/84). Post-interventional pain and Wexner scores were considerably reduced. The 2-month healing rate was 72% (18/25), whereas 73.6% of patients were symptom-free at 6 months. CONCLUSIONS PTNS is an effective alternative for the non-operative management of CAF. Due to several limitations further larger and higher quality studies are required.
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Affiliation(s)
| | - Ioannis Baloyiannis
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - Dimitrios Ragias
- Faculty of Medicine, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - Nikolaos Beis
- Faculty of Medicine, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | | | - Emmanouil Xydias
- Faculty of Medicine, University of Thessaly, Mezourlo, 41110, Larissa, Greece
| | - Konstantinos Tepetes
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
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Ibrahim R, Abounozha S, Mohamedahmed AYY, Alawad A, Abdel Rahim A. Incidence of anal incontinence among patients with anal fissure treated with Botox injection versus lateral sphincterotomy. Ann Med Surg (Lond) 2021; 68:102636. [PMID: 34386228 PMCID: PMC8346521 DOI: 10.1016/j.amsu.2021.102636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 11/12/2022] Open
Abstract
A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients with anal fissure, which technique has a lower of incidence anal incontinence: Botox injection or lateral sphincterotomy? The best evidence showed that Botox injection has lower incidence of incontinence. In patients with anal fissure. Which technique has a lower of incidence anal incontinence: Botox injection or lateral sphincterotomy? Botox injection has lower incidence of incontinence.
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Affiliation(s)
| | - Sabry Abounozha
- Northumbria Healthcare NHS Foundation Trust, Northumbria, UK
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