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However, there was no consensus on dosage, precise site of administration internal anal sphincter, external anal sphincter, or intersphincteric space and number of injections. For refractory anal fissures, surgery is still the treatment of choice. However, there is a considerable risk for incontinence.
Incontinence after a lateral internal sphincterotomy: are we underestimating it? The concept of fissurectomy, in combination with reversible chemical sphincterotomy or botoxwas first introduced by Engel et al.
Change The design of Your Jawline Along with Botox
The fissurectomy, as wound debridement, supports wound healing and botox injection Figure 2decreases the tonus of the internal anal sphincter temporary leading to an increased anal blood flow.
These results were in accordance with Lindsey et al. Sileri et al. Incontinence for flatus was described in 4. Surgical excision of fissure edges and sentinel skin tag. Triangle shape of excision facilitates wound drainage.
Résection chirurgicale des berges de la fissure avec sa marisque sentinelle. The significance of botox in the treatment of chronic anal fissures is still puzzling.
Data in the literature are inconsistent and final conclusions cannot be drawn. From our point of view, botox will not replace surgical treatment for refractory anal fissures. Fissurectomy and botox injection, however, treats both main causes of chronicity of anal fissures, the presence of bradytrophic scar tissue and the high resting anal pressure. This combined treatment strategy is very promising for the treatment of chronic anal fissures with a high success rate and a low morbidity and most importantly with very little risk of incontinence.
Français Español Italiano. Previous Article Une fistule royale aux conséquences inattendue… V. Journal page Archives Sommaire. Article Article Outline. Access to the text HTML. Access to the PDF text If you experience reading problems with Firefox, please follow this procedure. Recommend this article. Save as favorites. Service d'aide à la décision clinique Votre service d'aide à la décision clinique. Free Article! Combined fissurectomy and botulinum toxin injection : A new therapeutic approach for chronic anal fissures.
Soll, D. Dindo, D. Corresponding author. Outline Masquer le plan. Botulinum toxin. Aetiology and pathogenesis of anal fissures. Non-surgical treatment: the role of botox. Botox in the context of surgical treatments. Top of the page - Article Outline.