ABSTRACT

To investigate the results of high dose botulinum toxin injection as an alternative to surgery for the medical treatment refractory anal fissure.

11 patients were each injected 90 units of botulinum toxin in 2008-2012. Early (hematoma formation, infection) and late (temporary incontinence) complications, epithelialization of fissure and recurrence rates are noted.

Neither early nor late complications were encountered. Fissures healed in all of the 11 patients, one recurrence was observed in six months.

High dose botulinum toxin injection to anal sphincters is safe and achieves a high success rate for the treatment of anal fissure. If these results can be confirmed by a randomized trial, high dose botulinum toxin injection treatment may become an alternative for surgery or even the first line treatment for chronic anal fissure.