Behandlung der Analfissur mit Botulinumtoxin

Zusammenfassung

Die chronische Analfissur ist ein häufiges proktologisches Leiden. Für die chemische temporäre Denervierung kann Botulinumtoxin (BTX) eingesetzt werden. Die Applikation erfolgt mittels intramuskulärer Injektion in den äußeren oder inneren Sphincter ani. Wirkungsweise, Applikationstechnik, mögliche Komplikationen und Nebenwirkungen werden besprochen. Die Heilungsraten sind dosisabhängig und liegen kurzfristig (≤ 6 Monate) zwischen 60 und 90 %. Die Heilungsraten bei Nachbeobachtung > 1 Jahr erreichen ca. 50 %. Die Nebenwirkungen sind gering, Rezidive aber häufiger als bei chirurgischer Behandlung. Dennoch wird heute die Anwendung der konservativen Verfahren einschließlich BTX überwiegend in der First-Line-Therapie der chronischen Analfissur verwendet. Unter den chirurgischen Verfahren bleibt die laterale Sphinkterotomie der Goldstandard, der allerdings mit einer höheren Inkontinenz- und allgemeinen Morbiditätsrate einhergeht als dies für BTX der Fall ist.

Abstract

Chronic anal fissure is a common proctological disease. Botulinum toxin (BTX) can be used for temporary chemical denervation. The administration is by intramuscular injections into either the external or the internal anal sphincter muscles. The mode of action, administration techniques and possible complications or adverse effects of BTX therapy are discussed. The healing rate is dependent on the BTX dosage. The short-term healing rate (≤ 6 months) is between 60 and 90 %. In long-term follow-up studies (> 1 year), about 50 % of patients show a complete response. Adverse effects are generally mild but relapses occur more often compared to surgery. Conservative therapies including BTX are currently considered mostly as the first-line treatment. Among the surgical procedures, lateral sphincterotomy is the most effective treatment but shows higher incontinence and general morbidity rates than BTX.

Schlüsselwörter

Analfissur - Botulinumtoxin - laterale Sphinkterotomie - Therapiealgorithmus

Key words

anal fissure - botulinum toxin - lateral sphincterotomy - therapeutic algorithm

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