Peeroo Saania, Rajagopalan Ashray, Arachchi Asiri, Penfold Samuel, Roschach Blake, Nguyen Thang Chien, Teoh William
Department of Surgery, Monash Health, Melbourne, AUS.
Department of Surgery, Monash University, Melbourne, AUS.
Cureus. 2024 Feb 5;16(2):e53668. doi: 10.7759/cureus.53668. eCollection 2024 Feb.
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.
括约肌内注射肉毒杆菌毒素是肛裂的一种替代治疗方法，与诸如外侧内括约肌切开术等侵入性更强的手术相比，其大便失禁风险可能更低。目的是比较这两种治疗方法的治愈率和并发症发生率。方法：我们对2016年至2020年在澳大利亚墨尔本莫纳什健康中心结直肠外科接受括约肌内肉毒杆菌毒素治疗或外侧内括约肌切开术治疗肛裂的患者进行了回顾性审计，排除了之前接受过这两种手术的患者。结果：51例患者接受了括约肌内肉毒杆菌毒素治疗，40例患者接受了外侧内括约肌切开术。肉毒杆菌毒素组的大多数患者总剂量为80单位（53%；n = 27）或100单位（37%；n = 19），并在3点和9点位双侧给药（n = 41；80%）。肉毒杆菌毒素组31例患者（61%）症状完全缓解，平均治愈时间为两个月，而括约肌切开术组36例患者（90%）平均治愈时间为1.5个月。在大多数情况下，术后失禁是短暂的，尽管肉毒杆菌毒素组有1例患者持续性排气失禁，括约肌切开术组有2例患者持续性大便失禁。结论：括约肌内注射肉毒杆菌毒素是一种治疗肛裂的有效、侵入性较小的替代括约肌切开术的方法，失禁通常在发生时是暂时的。需要进一步研究以优化注射剂量和位置，并指导未来的建议。
