Treatment for anal fissure: Is there a safe option?

Am J Surg. 2017 Oct;214(4):623-628. doi: 10.1016/j.amjsurg.2017.06.004. Epub 2017 Jul 5.


Background: Surgeons often approach anal fissure with chemical denervation (Botulinum toxin, BT) instead of initial lateral internal sphincterotomy (LIS) due to concerns for long-term incontinence. We evaluated the characteristics and outcomes of patients who received BT or LIS.

Methods: We performed a retrospective chart review of patients undergoing LIS and BT for anal fissure between 2009 and 2015. In 2015, a telephone survey was performed to evaluate durability, long-term incontinence and patient satisfaction.

Results: Ninety-four patients met criteria: 73 LIS and 21 BT. Age (BT 49 vs. LIS 52) was similar between groups (p = 1.0). Cleveland Clinic Fecal Incontinence (CCFI) score pre-intervention was higher in BT than LIS patients (2.1 vs. 0.4, p = 0.007) with fewer BT patients with perfect continence (50% vs. 88%). Telephone survey response was 61%. Fissure recurrence was significantly higher for BT than LIS patients (36% vs. 9%, p = 0.03).

Conclusion: Patients undergoing LIS were less likely to recur. Both LIS and BT patients had some durable changes in continence raising the question of whether there is a safe technique.

Keywords: Anal fissure; Anorectal disease; Sphincterotomy.

MeSH terms

  • Adult
  • Botulinum Toxins, Type A / therapeutic use*
  • Female
  • Fissure in Ano / drug therapy*
  • Fissure in Ano / surgery*
  • Humans
  • Male
  • Middle Aged
  • Neuromuscular Agents / therapeutic use*
  • Patient Satisfaction*
  • Practice Patterns, Physicians' / statistics & numerical data
  • Retrospective Studies
  • Surveys and Questionnaires
  • Treatment Outcome


  • Neuromuscular Agents
  • Botulinum Toxins, Type A