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Comparison of Glycerine Trinitrate and Botulinum Toxin-A for the Treatment of Chronic Anal Fissure: Long-Term Results

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Diseases of the Colon & Rectum

Purpose

This study was designed to compare the efficacy of two different “chemical sphincterotomies” for chronic anal fissure.

Methods

From January to December 2001, 30 consecutive patients (17 males; mean age, 41.8 years) with chronic posterior anal fissure were enrolled. The patients were randomly assigned to receive 0.2 percent glycerine trinitrate ointment applied three times daily at theanal margin for eight weeks (Group A) or 20 units Botulinum toxin A injection into the internal anal sphincter on each side of the anterior midline (Group B). The patients were reviewed at 15 days, 1, 3, 6, 12, and every other 12 months. Follow-up ranged between 36 and 46 months. Patients in either group who failed to improve were referred for surgical treatment.

Results

Twelve patients in Group A and 11 in Group B had improvement or relief from symptoms at the first visit. The fissure was healed in ten patients in Group A and in eight in Group B within three months (66.7 and 57.1 percent). Recurrence of the fissure occurred in five patients in each group during the follow-up. The healing rate at three years was 40 and 33.3 percent for Group A and B, respectively. No patients in either group reported serious adverse effects; however, three patients in Group A (20 percent) had transient headache. None had fecal incontinence.

Conclusion

Both treatments may be considered as first-line treatment even if less effective than surgery.

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Authors and Affiliations

  1. Scientific Institute S. Raffaele Hospital, University Vita-Salute S. Raffaele, Milan, Italy

    Paola De Nardi M.D., Enrico Ortolano M.D. & Carlo Staudacher M.D.

  2. Unit of Medical Statistics, S. Paolo Hospital, University of Milan, Milan, Italy

    Giovanni Radaelli Ph.D.

  3. Chirurgia Generale e Gastroenterologica, Ospedale San Raffaele, Via Olgettina 60, 20132, Milano, Italy

    Paola De Nardi M.D.

Authors
  1. Paola De Nardi M.D.
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  2. Enrico Ortolano M.D.
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  3. Giovanni Radaelli Ph.D.
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  4. Carlo Staudacher M.D.
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Corresponding author

Correspondence to Paola De Nardi M.D..

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De Nardi, P., Ortolano, E., Radaelli, G. et al. Comparison of Glycerine Trinitrate and Botulinum Toxin-A for the Treatment of Chronic Anal Fissure: Long-Term Results. Dis Colon Rectum 49, 427–432 (2006). https://doi.org/10.1007/s10350-005-0287-2

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  • DOI: https://doi.org/10.1007/s10350-005-0287-2

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