Introduction
Chronic anal fissure
Treatment strategies and safety
Fissurectomy combined with botulinum toxin A injection
Efficacy
Reference | Patients n | Medicine | Dose (in IU) | Time to follow-up | Symptomatic improvement (in %) | Healing rate (in %) | Safety (in %) | Recurrence (in %) |
---|---|---|---|---|---|---|---|---|
Andicoechea Agorría et al. 2019 | 52 | Botulinum toxin A, BTA (Botox®, Allergan, Inc.; Irvine, CA, USA) | 33–50 | – | n.a. | 94.2 | Not reported | n.a. |
27 months | Not reported | Not reported | Not reported | 34.7 | ||||
Barnes et al. 2015 | 103 | Botulinum toxin A, BTA (Botox®, Allergan, Marlow, Buckinghamshire, United Kingdom) | 100 | 12 weeks | 95 | Complete: 67 Incomplete: 28 No healing: 5 | Temporary light FI: 7 (liquid/flatus); absent after 12 weeks | Not reported |
12 monthsa | Symptom-free: 100 | n.a. | No FI | Not reported | ||||
Median 33 monthsb | n.a. | n.a. | n.a. | No recurrence | ||||
Karabulut et al. 2012 | 36 | Botulinum toxin A (Botox®, Abdi İbrahim, Istanbul, Türkiye) | 20 | 2 weeks | Symptom-free: 61 Incomplete: 28 Persistent symptoms: 11 | Not reported | Not reported | n.a. |
4 weeksc | Symptom-free: 78 Incomplete: 11 Persistent symptoms: 11 | Complete: 78 | Not reported | Not reported | ||||
8 weeks | Symptom-free: 78 Incomplete: 11 Persistent symptoms: 11 | Not reported | Not reported | Not reported | ||||
Patti et al. 2010 | 10 | Botulinum toxin A, BTA (Botox®, Allergan, Westport, Irleand) | 30 | 30 days | Symptom-free: 100 | Complete: 100 | FI: 30 (3 patients) | n.a. |
12 months | Not reported | Not reported | FI: 10 (1 patient) | No recurrence | ||||
Witte et. 2009 | 21 | Botulinum toxin A, BTA (Dysport®, Ipsen, Hoofddorp, The Netherlands) | 80 (20) | 12 weeks | Symptom-free: 76 Incomplete: 14 | Complete: 90 No healing: 10 | Temporary light FI: 14 (liquid/flatus) | n.a. |
Arthur et al. 2008 | 28 | Botulinum toxin A, BTA (Botox®) | 40 | 12 weeks | Symptom-free: 90 | No healing: 10 | Temporary FI: 7 (soiling) | n.a. |
Baraza et al. 2008 | 46 | Botulinum toxin A, BTA (Botox®, Marlow, Buckinghamshire, United Kingdom) | 25–100 | 11 months | Symptom-free: 78 | Healing: 78 No healing: 22 | Urge FI: 2 Chronic perianal sepsis: 2 (1 patient) | n.a. |
22 months | Symptom-free: 28 | Not reported | Chronic perianal sepsis: 3 | 40–50 | ||||
Scholz et al. 2007 | 40 | Botulinum toxin A, BTA (Botox®, Allergan, Lachen, Switzerland) | 10 | 6 weeksd | Symptom-free: 65 Persistent symptoms: 10 | After 1st treatment: Complete: 25 Incomplete: 65 No healing: 10 After 2nd treatment: Complete: 90 | FI: 4.5 (1 patient) | n.a. |
12 months | For pain: 92 For Bleeding: 100 | Healing: 79 | Not reported | 10 | ||||
Sileri et al. 2007 | 22 | Botulinum toxin A, BTA (Botox®, Allergan, Milan, Italy) | 25 | 19 months | n.a. | Complete: 82 | Temporary FI and flatus: 6 | 14 |
Lindsey et al. 2004 | 30 | Botulinum toxin A, BTA (BotoxTM, Allegan, High Wycombe, United Kingdom) | 25 | 8 weeks | Not reported | Complete: 93 Unhealed: 7 | Temporary flatus FI: 7 | n.a. |
16 weeks | Not reported | Complete: 93 | None | n.a. | ||||
On average: (a mean calculated on the outcomes reported in the studies) | Short term: <12 months | 78 | 86 | 6 | 3 | |||
Long term: ≥12 months | n.a. | n.a. | 0 | 22 |