Title: IS CHEMODENERVATION WITH INCOBOTULINUMTOXINA AN
ALTERNATIVE TO INVASIVE CHRONIC ANAL FISSURE TREATMENTS?
Version: 3 Date: 14 Jul 2024
Reviewer:  Michele Schiano di Visconte
Reviewer's report:
Thank you for the opportunity to review this study on a very important topic.
The Authors state that treatment with botulinum toxin type A is strongly recommended for
the treatment of anal fissure: the analysis of the Literature does not confirm their statement.
“Botulinum toxin has similar results compared with topical therapies as first-line therapy for
chronic anal fissures and modest improvement in healing rates as second-line therapy following
failed treatment with topical therapies. The American Society of Colon and Rectal Surgeons
Clinical Practice Guidelines for the Management of Anal Fissures. Dis Colon Rectum 2022; 66:
190–199".   The Authors add the reference to their statement.
The authors report a cure rate of 83.9%. I congratulate you on the high recovery rate.
The selection criteria should be better specified.  The authors should explain the mechanism
of action of botulinum toxin. The authors should specify how many days after the end of the
GNT or   calcium channel blockers  they performed the botulinum toxin injection. The Authors
should specify the classification of the anal fissure and what type of anal fissure is being treated.
There is some confusion among the reported data. The 2-year cure rate should be evaluated on
the entire cohort of patients who have completed treatment.
The authors report the reduction in anal resting pressure after the treatment. It would be
interesting to know the starting values to evaluate the possible appearance of fecal incontinence.
The Authors indicate that 7 patients reported mild incontinence. Authors should specify the
Wexner index before and after the study
I believe the study has many methodological errors and the Study design section should be
rewritten
Title: IS CHEMODENERVATION WITH INCOBOTULINUMTOXINA AN
ALTERNATIVE TO INVASIVE CHRONIC ANAL FISSURE TREATMENTS?
Version: 3 Date: 14 Jul 2024
Reviewer:  Michele Schiano di Visconte
Reviewer's report:
Thank you for the opportunity to review this study on a very important topic.
The Authors state that treatment with botulinum toxin type A is strongly recommended for
the treatment of anal fissure: the analysis of the Literature does not confirm their statement.
“Botulinum toxin has similar results compared with topical therapies as first-line therapy for
chronic anal fissures and modest improvement in healing rates as second-line therapy following
failed treatment with topical therapies. The American Society of Colon and Rectal Surgeons
Clinical Practice Guidelines for the Management of Anal Fissures. Dis Colon Rectum 2022; 66:
190–199".   The Authors add the reference to their statement.
The authors report a cure rate of 83.9%. I congratulate you on the high recovery rate.
The selection criteria should be better specified.  The authors should explain the mechanism
of action of botulinum toxin. The authors should specify how many days after the end of the
GNT or   calcium channel blockers  they performed the botulinum toxin injection. The Authors
should specify the classification of the anal fissure and what type of anal fissure is being treated.
There is some confusion among the reported data. The 2-year cure rate should be evaluated on
the entire cohort of patients who have completed treatment.
The authors report the reduction in anal resting pressure after the treatment. It would be
interesting to know the starting values to evaluate the possible appearance of fecal incontinence.
The Authors indicate that 7 patients reported mild incontinence. Authors should specify the
Wexner index before and after the study
I believe the study has many methodological errors and the Study design section should be
rewritten
Please review this paper.
user
Title: IS CHEMODENERVATION WITH INCOBOTULINUMTOXINA AN
ALTERNATIVE TO INVASIVE CHRONIC ANAL FISSURE TREATMENTS?
Version: 3 Date: 14 Jul 2024
Reviewer:  Michele Schiano di Visconte
Reviewer's report:
Thank you for the opportunity to review this study on a very important topic.
The Authors state that treatment with botulinum toxin type A is strongly recommended for
the treatment of anal fissure: the analysis of the Literature does not confirm their statement.
“Botulinum toxin has similar results compared with topical therapies as first-line therapy for
chronic anal fissures and modest improvement in healing rates as second-line therapy following
failed treatment with topical therapies. The American Society of Colon and Rectal Surgeons
Clinical Practice Guidelines for the Management of Anal Fissures. Dis Colon Rectum 2022; 66:
190–199".   The Authors add the reference to their statement.
The authors report a cure rate of 83.9%. I congratulate you on the high recovery rate.
The selection criteria should be better specified.  The authors should explain the mechanism
of action of botulinum toxin. The authors should specify how many days after the end of the
GNT or   calcium channel blockers  they performed the botulinum toxin injection. The Authors
should specify the classification of the anal fissure and what type of anal fissure is being treated.
There is some confusion among the reported data. The 2-year cure rate should be evaluated on
the entire cohort of patients who have completed treatment.
The authors report the reduction in anal resting pressure after the treatment. It would be
interesting to know the starting values to evaluate the possible appearance of fecal incontinence.
The Authors indicate that 7 patients reported mild incontinence. Authors should specify the
Wexner index before and after the study
I believe the study has many methodological errors and the Study design section should be
rewritten
assistant