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Botulinum toxin for chronic anal fissure after biliopancreatic diversion for morbid obesity

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Author(s): Serafino Vanella | Giuseppe Brisinda | Gaia Marniga | Anna Crocco | Giuseppe Bianco | Giorgio Maria

Journal: World Journal of Gastroenterology
ISSN 1007-9327

Volume: 18;
Issue: 10;
Start page: 1021;
Date: 2012;
Original page

Keywords: Botulinum toxin | Anal diseases | Anal fissure | Severe obesity | Bariatric surgery | Biliopancreatic diversion

ABSTRACT
AIM: To study the effect of botulinum toxin in patients with chronic anal fissure after biliopancreatic diversion (BPD) for severe obesity. METHODS: Fifty-nine symptomatic adults with chronic anal fissure developed after BPD were enrolled in an open label study. The outcome was evaluated clinically and by comparing the pressure of the anal sphincters before and after treatment. All data were analyzed in univariate and multivariate analysis. RESULTS: Two months after treatment, 65.4% of the patients had a healing scar. Only one patient had mild incontinence to flatus that lasted 3 wk after treatment, but this disappeared spontaneously. In the multivariate analysis of the data, two registered months after the treatment, sex (P = 0.01), baseline resting anal pressure (P = 0.02) and resting anal pressure 2 mo after treatment (P < 0.0001) were significantly related to healing rate. CONCLUSION: Botulinum toxin, despite worse results than in non-obese individuals, appears the best alternative to surgery for this group of patients with a high risk of incontinence.
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