BACKGROUND: Botulinum toxin injection into the internal anal sphincter (IAS) is gaining popularity as a second line therapy for chronic @entity12395 after @entity1 fail medical therapy. The dosage of Botulinum toxin reported in the literature ranged from 20 to 50  IU. Complicated chronic anal fissure is defined as persistent fissure concurrent with other perianal pathology. We report a new approach involving high-dose circumferential chemodenervation (HDCC) of 100  IU in treating these complicated chronic @entity12395 . AIM: The aim of this study was to evaluate the fissure healing, complication, and recurrence rates with HDCC. METHODS: Complicated anal fissure was defined as fissure with other perianal pathologies including @entity272 , @entity1184 , @entity292 , symptomatic @entity6713 , @entity3502 , and abscess. Between 2008 and 2012, 62 consecutive @entity1 (28 Blacks, 33 Whites, 1 Hispanic) with complete follow-up data were included in this single arm study. These @entity1 underwent HDCC-IAS with addition interventions by a single colorectal surgeon. Follow up data were obtained by chart review and office follow up. RESULTS: Of the 62 @entity1 , the overall success rate was greater than 70% at 3 months follow-up. A few @entity1 developed transient @entity1241 , but shortly resolved. There was no major complication following HDCC-IAS. CONCLUSIONS: Combination therapy involving HDCC-IAS and local anorectal surgery for associated condition is both safe and effective for fissure healing.

Management of complicated chronic XXXX with high-dose circumferential chemodenervation (HDCC) of the internal anal sphincter.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity12395 :: ('MESH:D005401', 'Disease') :: ['anal fissures'] @entity1184 :: ('MESH:D006984', 'Disease') :: ['hypertrophied papilla'] @entity3502 :: ('MESH:D003218', 'Disease') :: ['anal condylomata'] @entity292 :: ('MESH:D005402', 'Disease') :: ['fistula'] @entity6713 :: ('MESH:D006484', 'Disease') :: ['hemorrhoids'] @entity272 :: ('MESH:D012871', 'Disease') :: ['skin tag'] @entity1241 :: ('MESH:D005242', 'Disease') :: ['flatus or fecal incontinence']
@entity12395 :: (MESH:D005401,Disease) :: ['anal fissures']
