Randomized clinical trial comparing botulinum toxin injections with 0.2 per cent nitroglycerin ointment for chronic anal fissure

Giuseppe Brisinda*, Federica Cadeddu, F. Brandara, G. Marniga, G. Maria

*Autore corrispondente per questo lavoro

Risultato della ricerca: Contributo in rivistaArticolo in rivista


Background: In recent years treatment of chronic anal fissure has shifted from surgical to medical. This study compared the ability of two non-surgical treatments - botulinum toxin injections and nitroglycerin ointment - to induce healing in patients with idiopathic anal fissure. Methods: One hundred adults were assigned randomly to receive treatment with either type A botulinum toxin (30 units Botox® or 90 units Dysport®) injected into the internal anal sphincter or 0.2 per cent nitroglycerin ointment applied three times daily for 8 weeks. Results: After 2 months, the fissures were healed in 46 (92 per cent) of 50 patients in the botulinum toxin group and in 35 (70 per cent) of 50 in the nitroglycerin group (P = 0.009). Three patients in the botulinum toxin group and 17 in the nitroglycerin group reported adverse effects (P < 0.001). Those treated with botulinum toxin had mild incontinence to flatus that lasted 3 weeks after treatment but disappeared spontaneously, whereas nitroglycerin treatment was associated with transient, moderate-to-severe headaches. Nineteen patients who did not have a response to the assigned treatment crossed over to the other therapy. Conclusion: Although treatment with either topical nitroglycerin or botulinum toxin is effective as an alternative to surgery for patients with chronic anal fissure, botulinum toxin is the more effective option. Copyright © 2007 British Journal of Surgery Society Ltd Published by John Wiley & Sons Ltd.
Lingua originaleEnglish
pagine (da-a)162-167
Numero di pagine6
RivistaBritish Journal of Surgery
Stato di pubblicazionePubblicato - 2007


  • Administration, Topical
  • Adult
  • Botulinum Toxins, Type A
  • Chronic Disease
  • Female
  • Fissure in Ano
  • Follow-Up Studies
  • Humans
  • Injections, Intralesional
  • Male
  • Middle Aged
  • Neuromuscular Agents
  • Nitroglycerin
  • Ointments
  • Treatment Outcome
  • Vasodilator Agents
  • Wound Healing


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