Meta-analysis of botulinum toxin injection for chronic anal fissure: healing rates controversies

Meta-analysis of botulinum toxin injection for chronic anal fissure: healing rates controversies

Dear Sir,

We read with interest the paper by Chen et al. [1], entitled “Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials.” Since its first description by Jost et al. [2] in 1993, botulinum toxin has proven to be a valid option in patients with chronic anal fissures who desire a non-surgical intervention or those with certain grades of incontinence [3].

The paper by Chen et al. reports the superiority of lateral internal sphincterotomy (LIS) on healing and recurrence rates. We have found some inconsistencies in their results shown in Figure 2A. According to the depicted forest plot, botulinum toxin seems to be associated with a better healing rate than LIS (overall effect is skewed to the left side of the value 1), which is not concordant with their conclusions. We also calculated the overall healing rate based on the studies they analyzed, and it is 66.34% (138/208) for botulinum toxin, and 92.53% (186/201) for LIS. The other results of the meta-analysis (complications, incontinence, and recurrence) are properly shown in the graphics. We would like to have a better explanation about this issue. Thank you.

References
1. Chen HL, Woo XB, Wang HS et al (2014) Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials. Tech Coloproctol 18:693–698
2. Jost WH, Schimrigk K (1993) Use of botulinum toxin in anal fissure. Dis Colon Rectum 36:974
3. Menteş BB, Irkörücü O, Akin M, Leventoğlu S, Tatlicioğlu E (2003) Comparison of botulinum toxin injection and lateral internal sphincterotomy for the treatment of chronic anal fissure. Dis Colon Rectum 46:232–237

Compliance with ethical standards
Conflict of interest: The authors declare that they have no conflict of interest.
Ethical approval: This article does not contain any studies with human participants or animals by any of the authors.
Informed consent: For this type of study formal consent is not required.

Referencia: https://link.springer.com/article/10.1007/s10151-016-1563-y

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