TTP3.08 Botulinum toxin versus botulinum toxin plus GTN ointment in the management of chronic anal fissures: a systematic review and meta-analysis

Introduction The objective of this study is to compare botulinum toxin (BT) and botulinum toxin plus glyceryl trinitrate (GTN) between patients undergoing treatment for symptomatic chronic anal fissures. Methods Standard medical databases such as MEDLINE, Embase, Pubmed, and Cochrane Library were searched to find randomized, controlled trials comparing BT and BT plus GTN ointment in patients undergoing treatment for symptomatic chronic anal fissures. All data were analyzed using Review Manager Software 5.4, and the meta-analysis was performed by using a random effect model analysis. Results A total of 3 randomized, control trials were included recruiting 151 patients with chronic anal fissures, which were treated either BT plus placebo or BT plus GTN topical ointment. In the random effect model analysis, there was no significant difference in healing rates between topical use of BT injection in the internal anal sphincter [Risk ratio: 1.04, 95% confidence interval, 0.73, 1.47, z = 0.21, p = 0.83] with or without use of topical GTN ointment. Conclusion Topical use of BT injection in the internal anal sphincter with or without use of topic GTN ointment are equally effective in the management of chronic anal fissure. However, due to the paucity of randomized, controlled trials, a major multicentre randomized controlled trial is mandatory to validate these findings.