Comparative Efficacy and Safety of Botulinum Toxin and Nitroglycerin in the Treatment of Chronic Anal Fissures: A Systematic Review and Meta-Analysis of Clinical Trials.

BACKGROUND: Chronic anal fissures (CAF) are a common anorectal condition that significantly impacts patients' quality of life. Treatment options include pharmacological therapies, such as botulinum toxin (BT) and topical nitroglycerin (TNG). Despite their widespread use, the relative efficacy and safety of BT and TNG remain controversial. This systematic review and meta-analysis is aimed at comparing the effectiveness, recurrence rates, and adverse effects of BT and TNG in the treatment of CAF. METHODS: A comprehensive search was conducted across multiple databases, including PubMed, Scopus, and Cochrane. Studies were included if they compared BT with TNG in the treatment of CAF. Ten clinical trials, comprising 698 patients, were included. Data were extracted and analyzed using STATA, and risk ratios were calculated for healing rates, recurrence rates, and side effects. RESULTS: The analysis showed that BT resulted in significantly higher healing rates compared with TNG (risk ratio: 1.18, 95% CI: 1.02-1.36, p = 0.029). However, there was no significant difference in recurrence rates between the two treatments (p = 0.146). BT was associated with a significantly lower incidence of side effects, including headaches, compared with TNG (p < 0.001). CONCLUSION: BT is more effective than TNG in the healing of CAF, with a superior safety profile. These findings suggest that BT may be the preferable treatment option for CAF.