Introduction:

Chronic anal fissure is a frequent entity that produces discomfort during and after defecation. Its pathophysiology is not clear and its management is varied. Lateral internal sphincterotomy is one of the most used techniques, although its high percentage of incontinence is not accepted; botulinum toxin injection is therefore a tempting alternative.

Objective:

To compare the results of botulinum toxin type A injection or lateral internal sphincterotomy for treatment of anal fissure in terms of postoperative pain, recurrence, healing and incontinence.

Methods:

A cohort study was carried out. One group of 40 patients were treated with injection of 50 IU of botulinum toxin type A and another group of 42 patients underwent lateral internal sphincterotomy. The results were statistically compared with a confidence interval of 95% and error of 0.05.

Results:

Sphincterotomy and botulinum toxin were effective in terms of healing in 85.4% and 77.5% of cases, respectively. Recurrences occurred in 4.8% and 12.5% of cases, respectively. Incontinence occurred in 9.5% and 2.5% of cases, respectively. Postoperative pain was present in 14.8% and 5.0% of cases, respectively.

Conclusions:

Sphincterotomy was better in terms of healing and recurrence, while botulinum toxin application showed better results regarding fecal incontinence and postoperative pain.

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