Fissurectomy Combined with High-Dose Botulinum Toxin Is a Safe and Effective Treatment for Chronic Anal Fissure and a Promising Alternative to Surgical Sphincterotomy

Dis Colon Rectum. 2015 Oct;58(10):967-73. doi: 10.1097/DCR.0000000000000434.


Background: There is paucity of data on the long-term outcome of the combination of fissurectomy and botulinum toxin A injection for the management of chronic anal fissure.

Objectives: The aim of this study is to assess the safety, efficacy, and long-term outcome of the combination of fissurectomy and botulinum toxin A injection.

Design: This is a nonrandomized prospective cohort study.

Settings: This study was conducted at a district general hospital in the United Kingdom.

Patients: The cohort included all patients treated with fissurectomy and botulinum toxin A for chronic anal fissure between September 2008 and March 2012.

Intervention: The patients were treated with a combination of fissurectomy and botulinum toxin A injection.

Main outcome measures: Symptomatic relief, fissure healing, complications, recurrence, and the need for further surgical intervention.

Results: One hundred and two patients received fissurectomy and botulinum toxin A injection for chronic anal fissure. At 12-week follow-up, 68 patients had resolution of symptoms and complete healing of chronic anal fissure, 29 patients had improvement of symptoms but incomplete healing and had further topical or botulinum toxin A treatment with subsequent complete healing. Ninety-five patients (93%) reported no postoperative complications. Seven patients reported a degree of incontinence in the immediate postoperative period. All reported normal continence at12-week follow-up. No local complications were observed or reported. At the mean follow-up of 33 months, there was no evidence of recurrence. Twelve-month follow-up was conducted via telephone interview only.

Limitations: This study is nonrandomized and did not examine the dose response of Botulinum Toxin A.

Conclusions: Fissurectomy combined with high-dose botulinum toxin A is a safe, effective, and durable option for the management of chronic anal fissure and a promising alternative to surgical sphincterotomy.

MeSH terms

  • Adult
  • Anal Canal* / physiopathology
  • Anal Canal* / surgery
  • Botulinum Toxins, Type A / administration & dosage*
  • Chronic Disease
  • Cohort Studies
  • Disease Management
  • Dissection* / adverse effects
  • Dissection* / methods
  • Fecal Incontinence* / diagnosis
  • Fecal Incontinence* / etiology
  • Female
  • Fissure in Ano* / drug therapy
  • Fissure in Ano* / physiopathology
  • Fissure in Ano* / surgery
  • Humans
  • Male
  • Neuromuscular Agents / administration & dosage
  • Postoperative Complications / diagnosis*
  • Prospective Studies
  • Recurrence
  • Treatment Outcome
  • United Kingdom
  • Wound Healing


  • Neuromuscular Agents
  • Botulinum Toxins, Type A