{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T15:55:22Z","timestamp":1762876522021,"version":"3.44.0"},"reference-count":39,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T00:00:00Z","timestamp":1727654400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Anal fissures are a debilitating benign condition, thought to be due to the hypertonicity of the internal anal sphincter resulting in localized ischaemia inhibiting healing. There are several surgical and non\u2010surgical treatment options for chronic anal fissures. Clinical practice surveys report a trend toward sphincter\u2010sparing options, reserving the more successful treatment of lateral sphincterotomy, with an incontinence rate up to 10%, for refractory fissures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A search of MEDLINE, Cochrane Database of Systematic Reviews and EMBASE for studies assessing sphincter\u2010sparing treatment with botulinum toxin and fissurectomy was performed following PRISMA guidelines. Outcomes assessed included healing rate, persistence, recurrence, re\u2010intervention and incontinence rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifteen non\u2010randomized studies assessed 978 patients managed with botulinum toxin and fissurectomy. The mean age was 40.8\u2009years with a female predominance of 58.9%. Healing rate was reported on 14 of the 15 studies, with a healing rate of 81% (95% CI:0.67, 0.90). Persistence rate was reported as 15% (95% CI:0.07, 0.28) and a recurrence rate of 6% (95% CI: 0.01, 0.19). Re\u2010intervention was required in 8% of patients with 55.1% requiring a repeat dose of botulinum toxin with or without fissurectomy. Incontinence appears to be transient with studies reporting a rate of 1% with median long\u2010term follow up 23\u2009months (range: 5\u201360\u2009months).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Combination fissurectomy and botulinum toxin is a safe and viable sphincter sparing treatment option, with moderate success rate and negligible complications. Randomized controlled trials are required to further strengthen the evidence for its use in chronic anal fissures.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.19248","type":"journal-article","created":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T01:29:20Z","timestamp":1727746160000},"page":"293-303","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of combined botulinum toxin and fissurectomy on chronic anal fissures \u2013 a systematic review"],"prefix":"10.1111","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6731-6101","authenticated-orcid":false,"given":"Rakesh","family":"Quinn","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery Nepean Hospital  Kingswood New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuleta","family":"Jamsari","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Nepean Hospital  Kingswood New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary KK","family":"Low","sequence":"additional","affiliation":[{"name":"Research Directorate Nepean Hospital  Kingswood New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7834-1767","authenticated-orcid":false,"given":"Sinan","family":"Albayati","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Nepean Hospital  Kingswood New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,9,30]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-230X-14-129"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000735"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.16762"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-003-0430-2"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.14466"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-020-03699-4"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2021.11.030"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-016-3693-9"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000612"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-017-1664-2"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00053-020-00454-9"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000002664"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-022-04115-9"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13304-023-01661-x"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2010.02.007"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_2_8_18_1","unstructured":"Sch\u00fcnemannH Bro\u017cekJ GuyattG A O. GRADE Handbook for Grading Quality of Evidence and Strength of Recommendations: The GRADE Working Group 2013;2013. Available from URL:guidelinedevelopment.org\/handbook."},{"key":"e_1_2_8_19_1","unstructured":"GRADEpro Guideline Development Tool [Software]: McMaster University and Evidence Prime;2024. Available from URL:gradepro.org."},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-008-0444-4"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v9.i32.9722"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-021-04057-8"},{"key":"e_1_2_8_23_1","first-page":"135","article-title":"The impact of fissurectomy combined with botulinum toxin injection in the treatment of chronic anal fissure","volume":"17","author":"Karabulut K","year":"2012","journal-title":"Firat Tip Dergisi"},{"key":"e_1_2_8_24_1","article-title":"Long\u2010term follow\u2010up of Botox and Botox + Fissurectomy for chronic anal fissure","volume":"56","author":"Nagle D","year":"2013","journal-title":"Dis. Colon Rectum"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/00031348211050830"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/000313480907501013"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-010-1154-6"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-009-0562-7"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000434"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2009.02063.x"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-007-9161-8"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-006-0261-z"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.3393\/ac.2014.30.3.132"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2016.08.173"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amsu.2015.11.008"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1177\/00031348211023446"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-020-02195-9"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-017-1335-0"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-023-02780-8"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2011.02840.x"}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.19248","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T07:25:21Z","timestamp":1755588321000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.19248"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,30]]},"references-count":39,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1111\/ans.19248"],"URL":"https:\/\/doi.org\/10.1111\/ans.19248","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"type":"print","value":"1445-1433"},{"type":"electronic","value":"1445-2197"}],"subject":[],"published":{"date-parts":[[2024,9,30]]},"assertion":[{"value":"2024-07-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}