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 .
Influence of botulinum toxin site of injections on healing rate in patients with chronic anal fissure.
BACKGROUND Botulinum toxin induces healing in patients with idiopathic anal fissure . METHODS Fifty patients affected by posterior anal fissure were treated with 20 units of botulinum toxin , injection in the internal anal sphincter on each side of the posterior midline ( group I ) or on each side of the anterior midline ( group II ) . RESULTS At 2 months evaluation , a healing scar was observed in 15 patients of group I and in 22 patients of group II(P = 0.025 ) . Resting anal pressure was significantly different from the baseline values at 1-month as well as at 2-month check-ups in both groups , but the values were significantly lower in patients of group II . CONCLUSIONS The intersite comparison revealed that anterior injection of the internal anal sphincter result ed in improved lowering of resting anal pressure and produced an earlier healing scar
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 .