Gonyautoxin: New Treatment for Healing Acute and Chronic Anal Fissures

PURPOSE: The mayor symptoms of chronic anal fissure are permanent pain, intense pain during defecation that lasts for hours, blood in the stools, and sphincter cramps. It is subsequent to formation of fibrosis infiltrate that leads to an increased anal tone with poor healing tendency. This vi-cious circle leads to fissure recurrence and chronicity. This study was designed to show the efficacy of gonyautoxin infiltration in healing patients with anal fissures. METHODS: Gonyautoxin is a paralyzing phytotoxin produced by dino-flagellates. Fifty recruited patients received clinical exami-nation, including proctoscopy and questionnaire to evalu-ate the symptoms. Anorectal manometries were performed before and after toxin injection. Doses of 100 units of go-nyautoxin in a volume of 1 ml were infiltrated into both sides of the anal fissure in the internal anal sphincter. RE