WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

*Ahmed Ihsan Alaa, Bassam Jumaa Naji, Mustafa Raed Muhi, Ali Kamal Ghanim

ABSTRACT

Background: Anal fissures are common anorectal conditions characterized by a tear in the anoderm, often leading to significant pain and discomfort. Chronic anal fissures, typically defined as those persisting for more than six weeks, may require intervention beyond conservative measures. Aim of the study: This study aims to evaluate the effectiveness of lateral sphincterotomy and Botulinum toxin injection techniques in the treatment of anal fissures. Methods: This prospective study was conducted at Al-Imamain Al-Kadmain Teaching Hospital. Data was collected for 69 patients treated between 2022 and 2024, meeting strict inclusion and exclusion criteria. The LS group underwent surgical sphincterotomy under anesthesia, while the BTX injection group received 20 units of BTX via local injection. Follow-up assessments over six months included pain evaluation using the Visual Analog Scale, complication rates, and fissure recurrence. Results: Patients treated with LS had significantly lower rates of fissure recurrence (5.1% vs. 96.7%, p<0.001) and fissure pain beyond six months (5.1% vs. 93.3%, p<0.001) compared to the BTX group. Urine retention was more common in the LS group (35.9% vs. 0%, p<0.001), while fecal incontinence rates were similar between groups (p>0.9). Conclusion: Lateral sphincterotomy is more effective treatment for anal fissures in the long term than BTX injection. It is associated with significantly lower rates of recurrence and long-term pain. However, BTX injection may be preferred in specific clinical situations due to its lower complication rate, particularly regarding urinary retention.

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