Author/Authors :
KARABULUT, Koray Firat University - Faculty of Medicine - Department of General Surgery, Turkey , AYGEN, Erhan Firat University - Faculty of Medicine - Department of General Surgery, Turkey , KIRKIL, Cuneyt Firat University - Faculty of Medicine - Department of General Surgery, Turkey , CAMCI, Cemalettin Firat University - Faculty of Medicine - Department of General Surgery, Turkey , DOGRU, Osman Firat University - Faculty of Medicine - Department of General Surgery, Turkey , ESEN, Kazım Firat University - Faculty of Medicine - Department of General Surgery, Turkey , BULBULLER, Nurullah Firat University - Faculty of Medicine - Department of General, Turkey , AYTEN, Refik Firat University - Faculty of Medicine - Department of General Surgery, Turkey , ILHAN, Yavuz Selim Firat University - Faculty of Medicine - Department of General Surgery, Turkey
Abstract :
Objective: The aim of this prospective randomized study was to determine the outcome of fissurectomy combined with botulinum toxin type-A (BTX-A) on the healing of medically resistant fissures over that achieved with BTX-A alone. Materials and Methods: A total of 36 consecutive patients with chronic anal fissure located on posterior midline who failed healing after topical medical therapy were enrolled. The patients were divided into 2 groups. The patients were divided into, BTX and BTX+fissurectomy (FIS) groups. They were clinically checked 1, 2, 4, and 8 weeks after the procedures. Symptomatic relief, early postoperative complications, clinical and anoscopic findings were recorded. The demograpic and clinical parameters were compared using Mann-Whitney U and Chi-squre tests. Results: There were no significant difference between the two groups regarding the age and gender. The most common complaints were rectal bleeding, constipation and pain during and/or after defaecation. All of the procedures performed without any postprocedural complications. Symptoms were reduced significantly with respect to the preoperative value. Symtomatic relief was assesesed in more patients in BTX+FIS group than BTX only group, but the difference was not significant. On 4th week anoscopic examination, complete healing was assesed in 14 (%77.8) and 11 (%61.1) patients in BTX+FIS and BTX groups, respectively. The median follow-up was 5 months. There was no recurrence during the follow-up. None of the patients had continence disturbance. Conclusion: Although BTX-A injection is an effective and safe treatment option in patients with a posterior chronic anal fissure non-responsive to other medical treatments, combining it with fissurectomy does not increase the healing rate.
