The Effect of 3-Way Low-Dose Botox Toxin Treatment on Recurrence Rates in Chronic Anal Fissures

Abstract

Background: Botox toxin treatment is an effective method in chronic anal fissures. Although the risk of anal incontinence is very low in botox toxin treatment, the recurrence rates are very high. Therefore, it is necessary to develop new application methods that can reduce the recurrence rates. In our study, 3-way botox toxin treatment method was compared with one-way treatment in order to determine which method was more effective. Methods: Patients performed botox toxin treatment for chronic anal fissure in the single center between 2017 and 2021 were retrospectively studied. The rates of recurrence and anal incontinence after one-way(Group A) and 3-way(Group B) low-dose botox toxin treatment were compared. Visual analog scale and Cleveland Clinic Incontinence Score tests were performed before and after botox treatment. Results were compared statistically. Results: Early relapse rate was 28.5% in Group A, in Group B 9.0%. At the end of the 2-year follow-up, the total recurrence rate was 38.0% in Group A, 22.7% in Group B.Temporary anal incontinence rate was 4.7% in Group A, and 6.8% in Group B. There was no persistent anal incontinence in either group. The difference between the early relapse rates between Group A and Group B was statistically significant (p <0.05). The difference between anal incontinence rates according to Cleveland Clinic Incontinence Score was not statistically significant between the patients with GP A and Gp B (p> 0.05). Conclusion: 3-way low-dose botox toxin treatment is a more effective treatment method for preventing early recurrence than one-way treatment in chronic anal fissüres.