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Systematic review and meta-analysis of randomized controlled trials comparing botulinum toxin injection with lateral internal sphincterotomy for chronic anal fissure

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Abstract

Objective

The aim of this review is to systematically analyze the prospective randomized controlled trials on the efficacy of botulinum toxin injection (Botox) vs. lateral internal sphincterotomy (LIS) for the treatment of chronic anal fissure (CAF).

Materials and methods

A systematic review of the literature was undertaken. The prospective randomized controlled trials on the effectiveness of Botox vs. LIS for the management of CAF were selected according to specific criteria and analyzed to generate pooling data.

Results

Four studies encompassing 279 patients were qualified for the meta-analysis. There was a statistically significant higher healing in LIS group compared with Botox group (RR 1.31[1.57, 1.50] 95% CI, z = 4.11, p < 0.0001). Absolute benefit increase rate (ABI) is 23% for LIS group compared with Botox group. The recurrence rate was statistically significantly higher in Botox groups than in LIS groups (RR 5.83[2.96, 11.49] 95% CI, z = 5.09, p < 0.00001).LIS was associated with a high rate of minor anal incontinence as compared to Botox (RR 0.08[0.01, 0.59] 95% CI, z = 2.47, p = 0.01).

Conclusion

Botulinum toxin injection was associated with a higher rate of recurrent disease. LIS was more effective in healing chronic anal fissure.

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References

  1. Lund JN, Scholefield JH (1996) Aetiology and treatment of anal fissure. Br J Surg 83(10):1335–44

    Article  PubMed  CAS  Google Scholar 

  2. Nyam DC, Pemberton JH (1999) Long-term results of lateral internal sphincterotomy for chronic anal fissure with particular reference to incidence of fecal incontinence. Dis Colon Rectum 42(10):1306–10

    Article  PubMed  CAS  Google Scholar 

  3. Nelson R (2004) A systematic review of medical therapy for anal fissure. Dis Colon Rectum 47(4):422–431

    Article  PubMed  Google Scholar 

  4. Higgins J, Green S (eds). Cochrane handbook for systematic reviews of interventions 4.2.6. In The Cochrane library, 2006. Issue 4. Wiley: Chichester (updated September 2006).

  5. Dickersin K, Manheimer E, Wieland S, Robinson KA, Lefebvre C, McDonald S (2002) Development of the Cochrane Collaboration's CENTRAL Register of controlled clinical trials. Eval Health Prof 25:38–64

    PubMed  Google Scholar 

  6. Juni P, Altman DG, Egger M (2001) Systematic reviews in health care: Assessing the quality of controlled clinical trials. BMJ 323:42–46

    Article  PubMed  CAS  Google Scholar 

  7. Guyatt GH, Sackett DL, Cook DJ (1993) Users' guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA 270:2598–2601

    Article  PubMed  CAS  Google Scholar 

  8. Guyatt GH, Sackett DL, Cook DJ (1994) Users' guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? Evidence-Based Medicine Working Group. JAMA 271:59–63

    Article  PubMed  CAS  Google Scholar 

  9. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  PubMed  CAS  Google Scholar 

  10. Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M et al (1998) Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 352:609–613

    Article  PubMed  CAS  Google Scholar 

  11. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  Google Scholar 

  12. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  PubMed  CAS  Google Scholar 

  13. Arroyo A, Perez F, Serrano P et al (2005) Surgical versus chemical (botulinum toxin) sphincterotomy for chronic anal fissure: long-term results of a prospective randomized clinical and manometric study. Am J Surg 189:429–34

    Article  PubMed  CAS  Google Scholar 

  14. Mentes BB, Irkorucu O, Akin M et al (2003) Comparison of botulinum toxin injection and lateral internal sphincterotomy for the treatment of chronic anal fissure. Dis Colon Rectum 46(2):232–237

    Article  PubMed  Google Scholar 

  15. Iswariah H, Stephens J, Rieger N, Rodda D, Hewett P (2005) Randomized prospective controlled trial of lateral internal sphincterotomy versus injection of botulinum toxin for the treatment of idiopathic fissure in ano. ANZ J Surg 75(7):553–5 Jul

    Article  PubMed  Google Scholar 

  16. Massoud BW, Mehrdad V, Baharak T, Alireza Z (2005) Botulinum toxin injection versus internal anal sphincterotomy for the treatment of chronic anal fissure. Ann Saudi Med. Mar-Apr 25(2):140–2

    Google Scholar 

  17. Arroyo Sebastián A, Pérez Vicente F, Miranda Tauler E, Sánchez Romero A, Serrano Paz P, Calpena Rico R (2005) Surgical (close lateral internal sphincterotomy) versus chemical (botulinum toxin) sphincterotomy as treatment of chronic anal fissure. Med Clin (Barc) 124(15):573–5

    Article  Google Scholar 

  18. Utzig MJ, Kroesen AJ, Buhr HJ (2003) Concepts in pathogenesis and treatment of chronic anal fissure–a review of the literature. Am J Gastroenterol 98(5):968–74

    PubMed  CAS  Google Scholar 

  19. Brisinda G, Maria G, Bentivoglio AR, Cassetta E, Gui D, Albanese A (1999) A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure. N Engl J Med 341(2):65–9

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

The authors thank Yu-Feng Wang for screening the related articles and the assistance she provided.

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Authors and Affiliations

  1. Department of Coloproctology, Nanjing TCM University Hospital, Nanjing, China

    Wan-Jin Shao

  2. Department of Epidemiology and Biostatistics, Nanjing TCM University, No.282 Hanzhong Road, Nanjing, China

    Guo-Chun Li

  3. Department of Medical Information Retrieval, Nanjing TCM University, Nanjing, China

    Zhi-Kun Zhang

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  1. Wan-Jin Shao
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Correspondence to Guo-Chun Li.

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Shao, WJ., Li, GC. & Zhang, ZK. Systematic review and meta-analysis of randomized controlled trials comparing botulinum toxin injection with lateral internal sphincterotomy for chronic anal fissure. Int J Colorectal Dis 24, 995–1000 (2009). https://doi.org/10.1007/s00384-009-0683-5

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