Background: Despite the superior success rate of lateral internal sphincterotomy for managing chronic anal fissure (CAF), there is a trend towards sphincter-preserving treatment due to the increased risk of incontinence. Botulinum toxin (BT) and fissurectomy are two sphincter-preserving options for CAF. We aim to assess if combining fissurectomy with botox treatment is superior to botulinum toxin alone in the management of CAF.

Methods: This retrospective cohort study was conducted across two Sydney hospitals over 7 years. All patients with a CAF managed with either BT and fissurectomy (group 1) or BT only (group 2) were included. Primary outcome was healing rate defined as resolution or significant improvement of perianal symptoms at initial follow-up. Secondary outcomes were persistence, recurrence, re-intervention and faecal incontinence rate. Follow-up questionnaire was conducted to compare long-term outcomes between the two groups.

Results: Fifty-seven patients met the inclusion criteria (group 1, 37; group 2, 20). Mean BT dose and injection location between the groups were similar (p = 0.259 and p = 0.427). There was a 65% response rate to the follow-up questionnaire. Median follow-up was 34.3 months (range 0.4-93). There was no difference in healing (56.7% vs. 50%, p = 0.561), recurrence (37.8% vs. 30%, p = 0.383) or re-intervention rate (13.5% vs. 20%, p = 0.888). Long-term incontinence rate was significantly higher in patients group 2 (0% vs. 10%, p = 0.010), with two patients reporting persistent flatus incontinence. Median overall satisfaction score was 3/4 (range 1-4), in both groups (p = 0.469).

Conclusion: Botulinum toxin with or without fissurectomy is a safe sphincter-sparing treatment option for CAF. However, the addition of fissurectomy to BT does not improve healing rates and we therefore recommend BT injection alone as a second-line treatment of CAF in patients who fail topical treatment.

Keywords: Botulinum toxins; Fecal incontinence; Fissure in ano; Treatment outcome.

© 2025. The Author(s).

背景： 尽管侧向内括约肌切开术在治疗慢性肛裂（CAF）方面的成功率较高，但由于存在大便失禁的风险增加，目前的趋势是倾向于采用保护括约肌的治疗方法。肉毒杆菌毒素（BT）和肛裂切除术是两种用于 CAF 的保括约肌选项。我们旨在评估将肛裂切除术与肉毒杆菌毒素治疗结合是否优于单独使用肉毒杆菌毒素在管理 CAF 方面更优。

方法： 这项回顾性队列研究在悉尼的两家医院进行了为期7年的研究。所有采用 BT 和肛裂切除术（第1组）或仅 BT 治疗的患者均被纳入研究中。主要结果是愈合率，定义为初次随访时周围肛门症状完全缓解或显著改善。次要结果包括持续性、复发性、再干预和大便失禁的发生率。通过随访问卷来比较两组之间的长期结果。

结果： 有57名患者符合纳入标准（第1组37人，第2组20人）。各组之间的 BT 剂量及注射位置相似 (P=0.259 和 P=0.427)。回复随访问卷的比率是65%。中位数随访期为34.3个月（范围0.4-93个月）。在愈合率（56.7% 对比 50%，P=0.561）、复发率（37.8%对比 30%，P=0.383）或再干预率（13.5%对比20%，P=0.888）方面，两组之间无差异。第2组患者长期大便失禁的发生率显著较高（0% 对比 10%，P=0.010），其中有两名患者报告持续的排气失禁问题。两组中位数总体满意度评分为3/4（范围1-4） (P=0.469)。

结论： 肉毒杆菌毒素与或不进行肛裂切除术是一种安全的保括约肌治疗 CAF 的选择。然而，将 BT 与肛裂切除术结合并不会改善愈合率，因此我们建议在患者对局部治疗无效的情况下，使用单剂肉毒杆菌注射作为第二线治疗方法。

关键词： 肉毒杆菌毒素；大便失禁；肛裂；疗效评估。