Traditionally, once conservative measures have failed, patients are referred to a colorectal specialist for assessment of anal fissure. The next step is often to perform examination under anaesthetic and inject botulinum toxin. In order to avoid the risks, time, and cost associated with general anaesthetic, it is possible to assess and inject botox in a clinic setting. This is currently not a widely accepted practice in the UK and continental Europe.
If i clearly understand, you would like to propose an amendment to the therapeutic tree, with an immediate botulinum toxin injection ? without diagnostic confirmation?
to my knowledge, initial treatment with botulinum toxin is proposed in 1st line (for spasticity) only in countries where this treatment is covered by the social security system. And requires monitoring.
did you evaluate others possibility to performe a correct examination, like sedated examination with nitrous oxide and analgesics, or hypnosis ?
No Emmanuelle, we see patients following failure of conservative measure including topical ointment. Instead of subjecting patients to a general anaesthetic though, we see them, re-examine them, take a thorough history and inject botox in clinic rather than under anaesthetic. Interested to know if anyone else has similar experience.
Dear Gary, you should contact Prof. Wolfgang Jost, as mentioned above.
KR
eric
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