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Gonyautoxin: New Treatment for Healing Acute and Chronic Anal Fissures

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

PURPOSE:

The mayor symptoms of chronic anal fissure are permanent pain, intense pain during defecation that lasts for hours, blood in the stools, and sphincter cramps. It is subsequent to formation of fibrosis infiltrate that leads to an increased anal tone with poor healing tendency. This vicious circle leads to fissure recurrence and chronicity. This study was designed to show the efficacy of gonyautoxin infiltration in healing patients with anal fissures.

METHODS:

Gonyautoxin is a paralyzing phytotoxin produced by dinoflagellates. Fifty recruited patients received clinical examination, including proctoscopy and questionnaire to evaluate the symptoms. Anorectal manometries were performed before and after toxin injection. Doses of 100 units of gonyautoxin in a volume of 1 ml were infiltrated into both sides of the anal fissure in the internal anal sphincter.

RESULTS:

Total remission of acute and chronic anal fissures were achieved within 15 and 28 days respectively. Ninety-eight percent of the patients healed before 28 days with a mean time healing of 17.6 ± 9 days. Only one relapsed during 14 months of follow-up. Neither fecal incontinence nor other side effects were observed. All patients showed immediate sphincter relaxation. The maximum anal resting pressures recorded after two minutes decreased to 56.2 ± 12.5 percent of baseline.

CONCLUSIONS:

Gonyautoxin breaks the vicious circle of pain and spasm that leads to anal fissure. This study proposes gonyautoxin anal sphincter infiltration as safe and effective alternative therapeutic approach to conservative, surgical, and botulinum toxin therapies for anal fissures.

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Authors and Affiliations

  1. Departamento de Cirugia, Seccion Proctologia, Hospital Clinico Universidad de Chile, Santiago, Chile

    Rogelio Garrido M.D., Mario Abedrapo M.D., Gunther Bocic M.D., Aldo Cuneo M.D., Hector Chiong M.D., Christian Jensen M.D., Rodrigo Azolas M.D. & Ana Henriquez T.M.,

  2. Lab. Bioquiimica de Membrana, Dept. de Fisiologia y Biofisica, Facultad de Medicina, Universidad de Chile, Santiago, Chile

    Nestor Lagos Ph.D., Karinna Lattes M.D. & Carlos Garcia M.Sc.

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  1. Rogelio Garrido M.D.
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  2. Nestor Lagos Ph.D.
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  3. Karinna Lattes M.D.
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  4. Mario Abedrapo M.D.
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  5. Gunther Bocic M.D.
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  6. Aldo Cuneo M.D.
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  9. Rodrigo Azolas M.D.
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  11. Carlos Garcia M.Sc.
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Correspondence to Nestor Lagos Ph.D..

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Supported by grants FONDECYT 1020090 and CSMAR 02/5-2, DID, Universidad de Chile.

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Garrido, R., Lagos, N., Lattes, K. et al. Gonyautoxin: New Treatment for Healing Acute and Chronic Anal Fissures. Dis Colon Rectum 48, 335–343 (2005). https://doi.org/10.1007/s10350-004-0893-4

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