This protocol addresses the next clinical step for patients with anal fissure in whom a repeat (subsequent) dose of botulinum toxin has failed to heal the fissure, or in whom healing occurred but the fissure has since recurred.
A repeat dose of botulinum toxin was administered after the initial dose did not achieve fissure healing, or after initial healing followed by recurrence. The goal — healing of the fissure — was not reached, prompting escalation to the present protocol.
The approach involves a surgical intervention combining botulinum toxin with a fissurectomy procedure performed under general or regional anaesthesia. The full sequence, technique details, and decision criteria are available in the complete protocol.
Healing of the fissure.
DOI: 10.1111/codi.167
When conservative management fails and the patient has botulinum toxin under general or regional anaesthesia, combination with fissurectomy may be considered.
Fissurectomy consists of curettage of the base of the fissure combined with excision of the fibrotic edges and sentinel pile if present.
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