Combined Method of Surgical Treatment of Anal Fissure

NCT ID: NCT07268261

Last Updated: 2025-12-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

122 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-09-01

Study Completion Date

2026-09-01

Brief Summary

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The purpose of this study is to improve treatment outcomes for patients with chronic anal fissure.

Detailed Description

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A chronic anal fissure is a rupture of the mucous membrane of the anal canal, lasting more than 2 months and resistant to non-surgical treatment. This condition is accompanied by a strong pain syndrome during and after defecation (defecation). This condition is most often found in young and ablebodied adults, so the issue of treatment is of particular relevance.

The main cause of the development of a chronic anal fissure is a spasm of the internal sphincter. It should be eliminated first of all to ensure effective therapy. All the main treatment methods, such as medicinal relaxation of the internal sphincter with 0.4% nitroglycerin ointment, lateral subcutaneous sphincterotomy, and pneumodivulsion of the anal sphincter are aimed at its removal. However, the optimal method has not yet been developed. Non-surgical treatments are often attended by relapse of disease, while surgical treatment is often complicated by intestinal contents incontinence, usually gas and loose or hard stool in some occasions (grade 3 anal sphincter insufficiency). In particular, lateral subcutaneous sphincterotomy performed in such patients is associated with an increase in the degree of anal incontinence in the early postoperative period.

Botulinum Toxin Type A application in treatment of patients with chronic anal fissure (after fissure excision) is intended to improve the therapy results, namely to reduce the frequency and duration of anal sphincter insufficiency after sphincter spasm removal (reduction in the number of patients suffering from post-operative incontinence)

Conditions

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Chronic Anal Fissure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Parallel assignment. Comparative, randomized, prospective, single-center. clinical trial. Patients in the main group undergo excision of the fissure in combination with injection into internal sphincter Botulinum toxin type A In the control group, excision of the fissure was performed in combination with injection into internal sphincter Botulinum toxin type A with excision in combination with platelet rich plasma
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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main group

Patients of the main group undergo excision of the anal fissure with further relaxation of the internal sphincter with botulinum toxin A (40 units, injection into the internal anal sphincter at 1, 5, 7 and 11 hours, 10 units each)

Group Type EXPERIMENTAL

excision of the anal fissure with further relaxation of the internal sphincter with botulinum toxin A

Intervention Type PROCEDURE

patients undergo excision of the fissure in combination with drug relaxation of the internal sphincter with botulinum toxin type A at a dosage of 40 units of action; an additional injection of platelet-rich plasma is added

control group

Patients in the control group undergo excision of the anal fissure with further relaxation of the internal sphincter with botulinum toxin A (40 units, injection into the internal anal sphincter at 1, 5, 7 and 11 hours, 10 units each)

Group Type EXPERIMENTAL

excision of the anal fissure with further relaxation of the internal sphincter with botulinum toxin A

Intervention Type PROCEDURE

patients undergo excision of the fissure in combination with drug relaxation of the internal sphincter with botulinum toxin type A at a dosage of 40 units of action; an additional injection of platelet-rich plasma is added

Interventions

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excision of the anal fissure with further relaxation of the internal sphincter with botulinum toxin A

patients undergo excision of the fissure in combination with drug relaxation of the internal sphincter with botulinum toxin type A at a dosage of 40 units of action; an additional injection of platelet-rich plasma is added

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* • Patients with chronic anal fissure with spasm of anal sphincter

Exclusion Criteria

* • Inflammatory diseases of the colon

* Pectenosis
* Previous surgical interventions on the anal canal
* IV grade internal and external hemorrhoids
* Rectal fistula
* Severe somatic diseases at the decompensation stage
* Pregnancy and lactation
* Anal sphincter insufficiency
* Chronic paraproctitis
* Individual intolerance and hypersensitivity to botulinum toxin
* Myasthenia gravis and myasthenic syndromes
* History of allergic reaction to anticoagulants.
* Blood diseases (thrombocytopenia, splenomegaly, etc.)
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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State Scientific Centre of Coloproctology, Russian Federation

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Sergey A. Frolov, Ph.D

Role: PRINCIPAL_INVESTIGATOR

State Scientific Centre of Coloproctology, Russian Federation (SSCCRussia)

Locations

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SSCCRussia

Moscow, , Russia

Site Status RECRUITING

Countries

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Russia

Central Contacts

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Evgeny E. Zharkov, MD

Role: CONTACT

+79039689739

Ekaterina Yu. Lebedeva

Role: CONTACT

+79779558920

Facility Contacts

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Sergey A Frolov, phd

Role: primary

+79039689739 ext. 89039689739

Evgeny E Zharkov

Role: backup

+79039689739 ext. +79039689739

References

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Delechenaut P, Leroi AM, Weber J, Touchais JY, Czernichow P, Denis P. Relationship between clinical symptoms of anal incontinence and the results of anorectal manometry. Dis Colon Rectum. 1992 Sep;35(9):847-9. doi: 10.1007/BF02047871.

Reference Type BACKGROUND
PMID: 1511644 (View on PubMed)

Jorge JM, Wexner SD. Anorectal manometry: techniques and clinical applications. South Med J. 1993 Aug;86(8):924-31. doi: 10.1097/00007611-199308000-00016.

Reference Type BACKGROUND
PMID: 8351556 (View on PubMed)

Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993 Jan;36(1):77-97. doi: 10.1007/BF02050307.

Reference Type BACKGROUND
PMID: 8416784 (View on PubMed)

Nelson RL, Thomas K, Morgan J, Jones A. Non surgical therapy for anal fissure. Cochrane Database Syst Rev. 2012 Feb 15;2012(2):CD003431. doi: 10.1002/14651858.CD003431.pub3.

Reference Type BACKGROUND
PMID: 22336789 (View on PubMed)

Zetterstrom J, Mellgren A, Jensen LL, Wong WD, Kim DG, Lowry AC, Madoff RD, Congilosi SM. Effect of delivery on anal sphincter morphology and function. Dis Colon Rectum. 1999 Oct;42(10):1253-60. doi: 10.1007/BF02234209.

Reference Type BACKGROUND
PMID: 10528760 (View on PubMed)

Chen HL, Woo XB, Wang HS, Lin YJ, Luo HX, Chen YH, Chen CQ, Peng JS. Botulinum toxin injection versus lateral internal sphincterotomy for chronic anal fissure: a meta-analysis of randomized control trials. Tech Coloproctol. 2014 Aug;18(8):693-8. doi: 10.1007/s10151-014-1121-4. Epub 2014 Feb 6.

Reference Type BACKGROUND
PMID: 24500725 (View on PubMed)

Valizadeh N, Jalaly NY, Hassanzadeh M, Kamani F, Dadvar Z, Azizi S, Salehimarzijarani B. Botulinum toxin injection versus lateral internal sphincterotomy for the treatment of chronic anal fissure: randomized prospective controlled trial. Langenbecks Arch Surg. 2012 Oct;397(7):1093-8. doi: 10.1007/s00423-012-0948-2. Epub 2012 Mar 20.

Reference Type BACKGROUND
PMID: 22430300 (View on PubMed)

Bobkiewicz A, Francuzik W, Krokowicz L, Studniarek A, Ledwosinski W, Paszkowski J, Drews M, Banasiewicz T. Botulinum Toxin Injection for Treatment of Chronic Anal Fissure: Is There Any Dose-Dependent Efficiency? A Meta-Analysis. World J Surg. 2016 Dec;40(12):3064-3072. doi: 10.1007/s00268-016-3693-9.

Reference Type BACKGROUND
PMID: 27539490 (View on PubMed)

Gui D, Cassetta E, Anastasio G, Bentivoglio AR, Maria G, Albanese A. Botulinum toxin for chronic anal fissure. Lancet. 1994 Oct 22;344(8930):1127-8. doi: 10.1016/s0140-6736(94)90633-5.

Reference Type BACKGROUND
PMID: 7934496 (View on PubMed)

Stewart DB Sr, Gaertner W, Glasgow S, Migaly J, Feingold D, Steele SR. Clinical Practice Guideline for the Management of Anal Fissures. Dis Colon Rectum. 2017 Jan;60(1):7-14. doi: 10.1097/DCR.0000000000000735. No abstract available.

Reference Type BACKGROUND
PMID: 27926552 (View on PubMed)

Other Identifiers

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56IG701SSCC980

Identifier Type: -

Identifier Source: org_study_id

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