Does Adding a Fissurectomy to Botox Sphincterotomy Increase Success Rate or Just Cost?

Area of Science:

• Colorectal Surgery
• Gastroenterology

Background:

• Botulinum toxin (Botox) sphincterotomy is effective for anal fissures.
• Direct comparison of Botox sphincterotomy with and without fissurectomy is lacking.

Purpose of the Study:

• To compare the cost-effectiveness and outcomes of Botox sphincterotomy with versus without fissurectomy for anal fissure treatment.

Main Methods:

• Retrospective review of patients undergoing Botox sphincterotomy for anal fissure over 5 years.
• Comparison of outcomes including recurrence, need for further treatment, complications, and total charges between groups.

Main Results:

• The group without fissurectomy experienced higher recurrence rates (56.6% vs 31.0%) and required more Botox treatments.
• The fissurectomy group had significantly more complications (13.5% vs 0%).
• Median total charges were substantially lower for treatment without fissurectomy ($2,973 vs $17,925).

Conclusions:

• Botox sphincterotomy without fissurectomy is a cost-effective, viable treatment option for anal fissures.
• This approach offers reduced costs and lower complication rates, often avoiding anesthesia.
• Individualized patient assessment is crucial for selecting the optimal treatment strategy.