Efficacy of botulinum toxin in the treatment of chronic anal fissure: a comprehensive systematic review

Abstract

Acute anal fissure maintains a debilitating state that produces enduring wound damage on the anal mucosa while the internal anal sphincter demonstrates increased muscle tone. This study aims to conduct a comprehensive systematic review to evaluate the efficacy of botulinum toxin (BT) in the treatment of chronic anal fissure, synthesizing current evidence from clinical trials and observational studies to guide evidence-based practice. A review of systematic research investigates the performance and security along with extended outcomes linked to BT therapy for treating chronic anal fissure by analyzing 23 clinical studies. The healing response from BT injections reaches 60%-85% without producing headache side effects commonly experienced with topical glyceryl trinitrate (GTN) medications. Lateral internal sphincterotomy (LIS) produces excellent long-term healing results in 90%-95% of cases, although it leads to fecal incontinence risks at a 5%-15% rate. Expanding BT treatment usually necessitates additional injections or surgical intervention because of its high rate of recurrence over 1-3 years (30%-40%). Combining Botox treatment with GTN administration achieves healing rates between 70% and 80%, but studies provide inconsistent research data. The optimal dosage range for BT treatment is 20-30 units, while Botox performs equally well as Dysport in achieving these results. BT provides patients who do not want surgery the benefit of being a safe, minimally invasive procedure. At the same time, LIS offers a definitive solution for patients who cannot respond to other treatments. Research must establish standardized dose instructions while improving injection methods and developing extended strategies to stop relapses.

Keywords: anal fissure; botulinum toxin; diarrhea; nitroglycerin; recovery; recurrence; sphincterotomy.

Figure 1.

PRISMA flow diagram of the article selection process.