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Institution: Waikato Hospital - Hamilton, Aotearoa New Zealand
Purpose: Chronic anal fissures are a disabling condition. Botulinum A toxin (botox) injection to the anal sphincter is an established treatment option. In many centres in New Zealand (NZ) and Australia botox injection is performed under general anaesthesia (GA), resulting in significant resource consumption. We investigated the efficacy of healing chronic anal fissures with botox in the outpatient clinic (OPC) setting without sedation.
Methods: A retrospective audit was performed at Waikato Hospital, NZ, from September 2011 to September 2013. All patients underwent anorectal examination in a General Surgery OPC and botox injection was performed after clinical diagnosis of a chronic anal fissure. Demographic data and co-morbidity that might impact fissure healing rates were recorded. Patients were followed up with a phone call or in person after at least 2 weeks. Success was defined as patient-reported symptom resolution or improvement such that no further treatment was required.
Results: 163 patients treated during the study period (male=54, median age=40.5 [Range 15-88). At 2-week or subsequent evaluation, satisfactory symptom resolution was reported in 106 patients (65.0%) after one injection. Satisfactory symptom resolution was achieved in 134 patients (82.2%) after 2 or less botox injections. Refractory symptoms were reported after two injections in 29 patients (17.8%) who were then offered a 3rd botox injection in the outpatient clinic or examination under GA.
Conclusion: Botox injection in an OPC setting can achieve symptom resolution for chronic anal fissures with similar rates to injection under GA. Widespread adoption of this technique could allow for significant health resource savings.
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Dr Neeraj Khatri - , Mr Jesse Fischer -