Comparative Study between Botulinum Toxin and Lateral Sphincterotomy in the Treatment of Acute Anal Fissure

This prospective observational study compared the efficacy, safety, and tolerability of botulinum toxin (BTX) injection and lateral internal sphincterotomy (LIS) in treating acute anal fissure (AAF) in 50 patients at Alluri Sitaramaraju Academy of Medical Sciences, Eluru, from January 2021 to August 2022. Patients were randomly allocated into two groups: Group A (n=25) received BTX (20 units), and Group B (n=25) underwent open LIS under general anesthesia. Outcomes assessed included pain (using the Visual Analogue Scale [VAS]), healing rates, incontinence, recurrence, patient satisfaction, and hospital stay duration. At 24 hours post - treatment, Group A reported significantly lower pain (p=0.005), with 88% experiencing VAS ?3 compared to 20% in Group B. Healing was achieved in all Group A patients by 2 weeks, versus 60% in Group B (p=0.04). Incontinence occurred in 5 Group B patients (20%) but none in Group A (p=0.05). Recurrence at 6 months was higher in Group A (20%) than Group B (4%). Patient satisfaction was significantly higher with BTX (88%) than LIS (56%) (p=0.02), and hospital stay was shorter with BTX. BTX emerges as a safe, effective first - line treatment for AAF, though recurrence rates warrant addressing precipitating factors.