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 .
Comparison of Glycerine Trinitrate and Botulinum Toxin-A for the Treatment of Chronic Anal Fissure: Long-Term Results
Purpose This study was design ed to compare the efficacy of two different “ chemical sphincterotomies ” for chronic anal fissure . Methods From January to December 2001 , 30 consecutive patients ( 17 males ; mean age , 41.8 years ) with chronic posterior anal fissure were enrolled . The patients were r and omly assigned to receive 0.2 percent glycerine trinitrate ointment applied three times daily at theanal margin for eight weeks ( Group A ) or 20 units Botulinum toxin A injection into the internal anal sphincter on each side of the anterior midline ( Group B ) . The patients were review ed at 15 days , 1 , 3 , 6 , 12 , and every other 12 months . Follow-up ranged between 36 and 46 months . Patients in either group who failed to improve were referred for surgical treatment . Results Twelve patients in Group A and 11 in Group B had improvement or relief from symptoms at the first visit . The fissure was healed in ten patients in Group A and in eight in Group B within three months ( 66.7 and 57.1 percent ) . Recurrence of the fissure occurred in five patients in each group during the follow-up . The healing rate at three years was 40 and 33.3 percent for Group A and B , respectively . No patients in either group reported serious adverse effects ; however , three patients in Group A ( 20 percent ) had transient headache . None had fecal incontinence . Conclusion Both treatments may be considered as first-line treatment even if less effective than surgery
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 .