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Fırat Tıp Dergisi |
2012, Cilt 17, Sayı 3, Sayfa(lar) 135-138 |
[ Turkish ] [ Tam Metin ] [ PDF ] |
The Impact of Fissurectomy Combined with Botulinum Toxin Injection in the Treatment of Chronic Anal Fissure |
Koray KARABULUT, Erhan AYGEN, Cuneyt KIRKIL, Cemalettin CAMCI, Osman DOGRU, Kazım ESEN, Nurullah BULBULLER, Refik AYTEN, Yavuz Selim ILHAN |
Firat University Faculty of Medicine, Department of General Surgery, Elazig, Turkey |
Objective: The aim of this prospective randomized study was to determine the outcome of fissurectomy combined with botulinum toxin type-A
(BTX-A) on the healing of medically resistant fissures over that achieved with BTX-A alone.
Materials and Methods: A total of 36 consecutive patients with chronic anal fissure located on posterior midline who failed healing after topical medical therapy were enrolled. The patients were divided into 2 groups. The patients were divided into, BTX and BTX+fissurectomy (FIS) groups. They were clinically checked 1, 2, 4, and 8 weeks after the procedures. Symptomatic relief, early postoperative complications, clinical and anoscopic findings were recorded. The demograpic and clinical parameters were compared using Mann-Whitney U and Chi-squre tests. Results: There were no significant difference between the two groups regarding the age and gender. The most common complaints were rectal bleeding, constipation and pain during and/or after defaecation. All of the procedures performed without any postprocedural complications. Symptoms were reduced significantly with respect to the preoperative value. Symtomatic relief was assesesed in more patients in BTX+FIS group than BTX only group, but the difference was not significant. On 4th week anoscopic examination, complete healing was assesed in 14 (%77.8) and 11 (%61.1) patients in BTX+FIS and BTX groups, respectively. The median follow-up was 5 months. There was no recurrence during the follow-up. None of the patients had continence disturbance. Conclusion: Although BTX-A injection is an effective and safe treatment option in patients with a posterior chronic anal fissure non-responsive to other medical treatments, combining it with fissurectomy does not increase the healing rate. |
[ Turkish ] [ Tam Metin ] [ PDF ] |
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