Comparative Study of Lateral Anal Sphincterotomy Versus Botulinum Toxin Injection for Treatment of Chronic Anal Fissure

Asim  Aslam; Muhammad Jalil Malik; Madhia  Sundas; Farukh Gulzar  Khawaja; Ammad ud din  Nasir; Shahid  Abbas

doi:10.51253/pafmj.v75i3.9775

Authors

Asim Aslam Department of Surgery, Combined Military Hospital /National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Muhammad Jalil Malik Department of Surgery, Combined Military Hospital, Lahore/National University of Medical Sciences (NUMS) Pakistan
Madhia Sundas Department of Dermatology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Pakistan
Farukh Gulzar Khawaja Department of Surgery, Combined Military Hospital /National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Ammad ud din Nasir Department of Surgery, Combined Military Hospital, Pano Aqil/National University of Medical Sciences (NUMS) Pakistan
Shahid Abbas Department of Cardiology, Combined Military Hospital, Bahawalpur/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i3.9775

Keywords:

Chronic Anal fissure (CAF), Injection Botulinum Toxin, Lateral internal sphincterotomy (LIS), Postoperative Pain.

Abstract

Objective: To compare lateral internal sphincterotomy with injection Botulinum toxin for chronic anal fissure treatment in terms of improvement in mean postoperative pain, frequency of healing and fecal incontinence.

Study Design: Quasi-experimental study.

Place and Duration of Study: Combined Military Hospital, Rawalpindi, Pakistan, from Feb to Aug 2019.

Methodology: Among the patients reporting to Surgical Unit II of Combined Military Hospital Rawalpindi, Pakistan. 80 individuals with chronic anal fissure, 12- 60 years of age were included in the study. Patients who have recurrent disease, fistula in ano, hemorrhoids, cardiovascular disease, and coagulopathies were excluded. Group-A patients had lateral anal sphincterotomy as an elective case under spinal anesthesia. Whereas Botulinum Toxin A was administered under local anesthesia in internal anal sphincter in Group-B patients in the outpatient department (OPD). Patients were followed up at 1, 4, 8, and 12 weeks in the OPD.

Results: In Group-A, mean postoperative pain was found to be 3(4–2) in Group-A, and in Group-B was found to be 2( 2–1) with a significant p-value <0.001. Healing of fissure was seen in 26(65.0%) in Group-A and 34(85.0%) in Group-B (p-value=0.039). Temporary fecal incontinence was seen in 16(40.0%) in Group-A and 05(12.50%) in Group-B (p-value =0.005)

Conclusion: This study determined that in chronic anal fissure treatment, injection Botulinum toxin is superior to lateral internal sphincterotomy in postoperative pain, healing, and fecal incontinence.

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