Original Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Mar 14, 2012; 18(10): 1021-1027
Published online Mar 14, 2012. doi: 10.3748/wjg.v18.i10.1021
Botulinum toxin for chronic anal fissure after biliopancreatic diversion for morbid obesity
Serafino Vanella, Giuseppe Brisinda, Gaia Marniga, Anna Crocco, Giuseppe Bianco, Giorgio Maria
Serafino Vanella, Giuseppe Brisinda, Gaia Marniga, Anna Crocco, Giuseppe Bianco, Giorgio Maria, Department of Surgery, Catholic School of Medicine, University Hospital “Agostino Gemelli”, 00168 Rome, Italy
Author contributions: Vanella S and Brisinda G designed the research; Marniga G, Bianco G and Maria G performed the research and botulinum toxin treatment; Vanella S and Crocco A analyzed the data; Vanella S, Brisinda G and Crocco A wrote the paper.
Correspondence to: Dr. Giuseppe Brisinda, Department of Surgery, Catholic School of Medicine, University Hospital “Agostino Gemelli”, Largo Agostino Gemelli 8, 00168 Rome, Italy. gbrisin@tin.it
Telephone: +39-6-30154199 Fax: +39-6-30156086
Received: March 14, 2011
Revised: May 5, 2011
Accepted: January 22, 2012
Published online: March 14, 2012
Abstract

AIM: To study the effect of botulinum toxin in patients with chronic anal fissure after biliopancreatic diversion (BPD) for severe obesity.

METHODS: Fifty-nine symptomatic adults with chronic anal fissure developed after BPD were enrolled in an open label study. The outcome was evaluated clinically and by comparing the pressure of the anal sphincters before and after treatment. All data were analyzed in univariate and multivariate analysis.

RESULTS: Two months after treatment, 65.4% of the patients had a healing scar. Only one patient had mild incontinence to flatus that lasted 3 wk after treatment, but this disappeared spontaneously. In the multivariate analysis of the data, two registered months after the treatment, sex (P = 0.01), baseline resting anal pressure (P = 0.02) and resting anal pressure 2 mo after treatment (P < 0.0001) were significantly related to healing rate.

CONCLUSION: Botulinum toxin, despite worse results than in non-obese individuals, appears the best alternative to surgery for this group of patients with a high risk of incontinence.

Keywords: Botulinum toxin, Anal diseases, Anal fissure, Severe obesity, Bariatric surgery, Biliopancreatic diversion