Quality of Life in Patients Receiving Botulinum A Toxin Treatment for Symptomatic Anal Fissure

Bagul A and Carter P

Department of Colorectal Surgery, Royal Liverpool and Broadgreen University Hospitals, UK

^*Correspondance to: Anil Bagul 

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Abstract:

Aim: To quantify changes in quality of life of patients treated with Botulinum A for chronic anal fissure. Background and Literature Review: Anal fissures represent about 10% of colorectal clinic referrals. Chronicity is defined as a fissure that has persisted for greater than 6 weeks despite medical treatment. The underlying hypothesis is that chronic fissures have a raised resting anal pressure from internal anal sphincter hyper tonicity. Medical treatment for anal fissures includes GTN 0.2%/Diltiazem paste [1]. Resistant cases may be offered Botulinum Toxin or lateral internal sphincterotomy if Botox treatment fails. Sphincterotomy produces good healing rates but is associated with incontinence to flatus in up to 30% in long term follow up [2]. Prior to surgery, anal manometry should be performed on all cases except males who have not had previous anal surgery. If sphincter resting pressure is low, these refractory cases have a better outcome following an advancement flap procedure [3]. Meta analysis suggests medical treatment is safe for chronic anal fissure and reserves surgery for treatment failure [4-7].
Methodology: This observational study includes patients treated for chronic anal fissure. Patients qualifying for the study, with a diagnosis of chronic anal fissure, were entered into a database over a period of 2 years. Details of procedure carried out were verified from individual operation notes, demographics, symptoms; diagnosis and treatment details were recorded. Outcome measures used were patient symptoms and QOL scores. The Quality of life scores were recorded before and after respective procedure at follow up. The cohort of patients was assessed using the SF 36 Quality of Life Assessment Form [8-11]. The dimensions on SF-36 response score scale of 100 (best) to 0 (worst) were analyzed. The data are presented as median (range).
Results: The cohort included 24 patients. Fourteen patients were male. The median age was 48 (28-77) years. 95.83% patients completed the SF-36 form. This revealed that their quality of life improved significantly in physical functioning, pain, social functioning and mental health.
Conclusion: QOL data is rarely acquired in surgery so adds new knowledge to the study by using available tools to assess quality of life in patients undergoing minor surgical treatment. Our study shows improvement in the quality of life in patients treated with Botox for chronic anal fissure at follow up.

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Cite the Article:

Bagul A, Carter P. Quality of Life in Patients Receiving Botulinum A Toxin Treatment for Symptomatic Anal Fissure. World J Surg Surgical Res. 2019; 2: 1130.