Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2021; 9(32): 9722-9730
Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.9722
Botulinum toxin associated with fissurectomy and anoplasty for hypertonic chronic anal fissure: A case-control study
Beatrice D'Orazio, Girolamo Geraci, Fausto Famà, Gloria Terranova, Gaetano Di Vita
Beatrice D'Orazio, Girolamo Geraci, Gaetano Di Vita, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo 90100, Sicily, Italy
Fausto Famà, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Messina 98121, Sicily, Italy
Gloria Terranova, Department of Surgical, Oncological and Stomatological Sciences, Postgraduate Medical School in General Surgery, University of Palermo, Palermo 90100, Sicily, Italy
Author contributions: D’Orazio B, Geraci G and Di Vita G conceived, devised and designed the manuscript; Terranova G collected the cases and iconography; D’Orazio B and Geraci G wrote the manuscript and participated in the sequence alignment; Di Vita G and Famà F revised and approved the final manuscript and its conclusions; All authors contributed to the study.
Institutional review board statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The protocol for this study was submitted to the Ethical Committee of our institution “Ethical Committee Palermo 1-AUOP P. Giaccone” on March 1, 2018, which did not consider it necessary to approve it and waved, in that occasion, the requirement for ethical approval.
Informed consent statement: Informed written consent was obtained from all individual participants included in this study.
Conflict-of-interest statement: The authors report no conflicts of interest in this work. The authors declare that they have no competing interests. This article has not been presented or published elsewhere, and no financial support has been obtained for its preparation.
Data sharing statement: The datasets generated and/or analysed during the current study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gaetano Di Vita, MD, Chief Doctor, Professor, Surgeon, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, U.O. di Chirurgia Generale, Endoscopica, Diagnostica ed Interventistica, Palermo 90100, Sicily, Italy. divitagaetano@libero.it
Received: February 16, 2021
Peer-review started: February 16, 2021
First decision: May 4, 2021
Revised: May 7, 2021
Accepted: August 25, 2021
Article in press: August 25, 2021
Published online: November 16, 2021
Processing time: 266 Days and 13.8 Hours
Core Tip

Core Tip: Surgical sphincterotomy is still the approach of choice for the treatment of chronic anal fissure with internal anal sphincter hypertonia, even if it is burdened by a high risk of postoperative faecal incontinence. For this reason, sphincter-saving surgical procedures have recently been reconsidered to overcome this risk. In our work, we consider fissurectomy with anoplasty, and we wonder if the association with pharmacological sphincterotomy with botulinum toxin A injection may improve the outcomes in patients affected by chronic anal fissure with hypertonic internal anal sphincter. Therefore, this study aims to evaluate the results of the associated procedures in terms of reduction of faecal incontinence risk and recurrence rate and improvement of overall results in comparison with conventional sphincterotomy.