SP9.05 A systematic review evaluating the role of botulinum toxin injection in the internal anal sphincter versus lateral internal sphincterotomy in the management of chronic anal fissure

Introduction The objective of this study is to compare botulinum toxin injection in the internal anal sphincter (IAS) versus internal anal sphincterotomy in the management of patients with chronic anal fissure (CAF). Methods Standard medical databases such as MEDLINE, Embase, PubMed, and Cochrane Library were searched to find relevant randomized, controlled trials (RCTs). The data was analyzed using Review Manager Software 5.4, and the meta-analysis was performed with a random effect model analysis. Results A total of 12 RCTs were included in this meta-analysis recruiting 1181 patients undergoing treatment for CAF either by Botox injection in the IAS or by lateral internal sphincterotomy. In the random effect model analysis, lateral internal sphincterotomy was found to be more effective in the healing of CAF in 0-6-month Botox injection [Odds ratio: 0.21, 95% CI 0.08, 0.57, z = 3.06, p = 0.002). Lateral internal sphincterotomy was also associated with improved healing rates compared to Botox injection [Odds ratio: 0.11, 95% CI 0.05, 0.24, z = 5.73, p < 0.00001] in the IAS. Conclusion Surgical intervention through lateral internal sphincterotomy is associated with improved postoperative healing rate compared to Botox injection in the IAS in patients with CAF.