Comparative study of Botulinum Toxin Injection and Lateral Internal Sphincterotomy in the Treatment of Chronic Anal Fissure

Aims: Chronic anal fissure is a commonly seen, painful condition, which may require surgery. This study determines if Botulinum toxin injection can replace lateral internal sphincterotomy as treatment for the disease. Methods: This study- a randomised controlled trial included 60 patients. They were randomly divided into two groups, one half received Botulinum toxin injection and the other half underwent lateral internal sphincterotomy surgery. They were then followed up over a period of 3 months and data collected regarding relief of pain, return to daily activities, healing of fissure, wound infection, incontinence and recurrence. Results: Results showed that Botulinum toxin injection showed faster pain relief (40% vs 6.7% at day 1) and earlier return to daily activities when compared with surgery (mean: day 2 vs day 4). There was no significant difference between the two with respect to healing of fissure, wound infection and recurrence. However, incidence of incontinence was higher in the surgery group (10% vs 3.3%). Conclusion: Botulinum toxin injection can be considered as a suitable alternative to lateral internal sphincterotomy with advantage of being a quick and easy technique as well as causing less morbidity