BACKGROUND: Surgical sphincterotomy for chronic anal fissure can cause @entity1241 . This has led to the investigation of nonsurgical treatment options that avoid permanent damage to the internal anal sphincter. METHODS: We conducted a retrospective, ongoing chart review with telephone follow-up of 88 @entity1 treated for chronic anal fissure between November 1996 and December 2002. During the first half of the study period, @entity1 were treated with topical @entity1242 and pneumatic dilatation. With the availability of new therapies in June 1999, subsequent @entity1 received topical @entity594 and botulinum toxin injections (30-100 units). Lateral anal sphincterotomy was reserved for @entity1 who failed medical treatment. RESULTS: In 98% of @entity1 the fissure healed with conservative nonsurgical treatment. The combination of @entity594 and botulinum toxin was superior to @entity1242 and pneumatic dilatation with respect to both healing (94% v. 71%, p < 0.05) and recurrence rate (2% v. 27%, p < 0.01). There was no statistical difference between the number of dilatations and botulinum toxin injections needed to achieve healing. Three @entity1 who received botulinum toxin reported mild transient @entity322 . At an average telephone follow-up of 27 months, 92% of @entity1 reported having no @entity158 or only mild @entity158 with bowel movements. CONCLUSIONS: Chronic anal fissures can be simply and effectively treated medically without the risk of @entity322 associated with sphincterotomy. Topical @entity594 and botulinum toxin injections are an excellent combination, associated with a low recurrence rate and minimal side effects.

Nonsurgical treatment of chronic anal fissure: @entity1242 and dilatation versus XXXX and botulinum toxin.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity322 :: ('MESH:D014549', 'Disease') :: ['flatus incontinence', 'incontinence'] @entity1242 :: ('MESH:D005996', 'Chemical') :: ['nitroglycerin'] @entity158 :: ('MESH:D010146', 'Disease') :: ['occasional pain', 'pain'] @entity594 :: ('MESH:D009543', 'Chemical') :: ['nifedipine'] @entity1241 :: ('MESH:D005242', 'Disease') :: ['fecal incontinence']
@entity594 :: (MESH:D009543,Chemical) :: ['nifedipine']
