Type A botulinum toxin treatment for chronic anal fissure

We read with great interest the systematic review on efficacy and safety of botulinum toxin treatment in patients with anal fissure by E. Yiannakopoulou. The manuscript is well written, complete and exhaustive. The review of the literature data is careful and rigorous. This systematic review aimed to answer several primary questions. The intention to give an answer to all these questions makes the paper even more interesting. We agree with the author that botulinum toxin consists of an alternative effective therapeutic modality for the treatment of anal fissure.