Botox and CCBs were equivalent to GTN in efficacy with fewer adverse events .
No medical therapy came close to the efficacy of surgical sphincterotomy , though none in these RCTs was associated with the risk of incontinence .
Medical therapy for chronic anal fissure , acute fissure and fissure in children may be applied with a chance of cure that is marginally better than placebo , and , for chronic fissure in adults , far less effective than surgery
BACKGROUND Because of the disability associated with surgery for anal fissure and the risk of incontinence , medical alternatives for surgery have been sought .
Most recently , pharmacologic methods that relax the anal smooth muscle , to accomplish reversibly what occurs in surgery , have been used to obtain fissure healing .
OBJECTIVES To assess the efficacy and morbidity of various medical therapies for anal fissure .
Randomized Clinical Trial of Botulinum Toxin Plus Glyceryl Trinitrate vs. Botulinum Toxin Alone for Medically Resistant Chronic Anal Fissure: Overall Poor Healing Rates
Purpose This study was design ed to assess whether addition of glyceryl trinitrate to botulinum toxin improves the healing rate of glyceryl trinitrate-resistant fissures over that achieved with botulinum toxin alone . Methods Patients were r and omized between botulinum toxin plus glyceryl trinitrate ( Group A ) and botulinum toxin plus placebo paste ( Group B ) . Patients were seen at baseline , four and eight weeks , and six months . The primary end point was fissure healing at eight weeks . Secondary end points were symptomatic relief , need for surgery , side effects , and reduction in maximum resting and squeeze pressures . Results Thirty patients were r and omized . Two-thirds of patients had maximum anal resting pressures below or within the normal range at entry to the study . Healing rates in both treatment groups were disappointing . There was a nonsignificant trend to better outcomes in Group A compared with Group B in terms of fissure healing ( 47 vs. 27 percent ) , symptomatic improvement ( 87 vs. 67 percent ) , and resort to surgery ( 27 vs. 47 percent ) . Conclusions There is some evidence to suggest that combining glyceryl trinitrate with botulinum toxin is superior to the use of botulinum toxin alone for glyceryl trinitrate-resistant anal fissure . The poor healing rate may reflect the fact that many of the patients did not have significant anal spasm at trial entry
Botox and CCBs were equivalent to GTN in efficacy with fewer adverse events .
No medical therapy came close to the efficacy of surgical sphincterotomy , though none in these RCTs was associated with the risk of incontinence .
Medical therapy for chronic anal fissure , acute fissure and fissure in children may be applied with a chance of cure that is marginally better than placebo , and , for chronic fissure in adults , far less effective than surgery
BACKGROUND Because of the disability associated with surgery for anal fissure and the risk of incontinence , medical alternatives for surgery have been sought .
Most recently , pharmacologic methods that relax the anal smooth muscle , to accomplish reversibly what occurs in surgery , have been used to obtain fissure healing .
OBJECTIVES To assess the efficacy and morbidity of various medical therapies for anal fissure .