ABSTRACT

INTRODUCTION:

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

METHODS:

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.

RESULTS:

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

DISCUSSION AND CONCLUSION:

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.