P103 - Botulinum Toxin Versus Lateral Internal Sphincterotomy Quality (BLINQ) Project

Saturday, May 9, 2026

12:44 PM - 12:52 PM ET

Author(s)

Racquel S. Gaetani, MD (she/her/hers)

General Surgery Resident/Colorectal Research Fellow
LAHEY HOSPITAL AND MEDICAL CENTER
Lahey Hospital and Medical Center
Burlington, MA, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
CM

Cody W. Munroe, MS

Coordinator
Lahey Hospital and Medical Center
Burlington, Massachusetts, United States

Disclosure information not submitted.
KK

Kameron Ky, BS

Clinical Research Coordinator
Beth Israel Lahey Health Burlington
Lynn, Massachusetts, United States

Disclosure information not submitted.
Jonathan S. Abelson, MD MS (he/him/his)

Staff Surgeon
Lahey Hospital and Medical Center
Tufts Medical Center
Arlington, MA, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
Tess H. Aulet, MD (she/her/hers)

Colorectal Surgeon
UMass Memorial Medical Center
UMass Memorial Medical Center
Worcester, Massachusetts, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.
Vanessa Marie Baratta, MD, MHS

Colon and Rectal Surgeon
Colon and Rectal Surgeons of Greater Hartford
Ivoryton, Connecticut, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
Olga Beresneva, MD

Colorectal surgeon. Assistant professor.
Boston University/Boston Medical Center
Boston, Massachusetts, United States

Disclosure information not submitted.
Liliana Bordeianou, MD, MPHFASCRS

Professor of Surgery
Harvard Medical School; Mass General Brigham Division Colon and Rectal Surgery
Harvard
Boston, MA, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.
Marcella Bradway, MD (she/her/hers)

Chair, Department of Surgery
Berkshire Medical Center
Pittsfield, MA, United States

Disclosure information not submitted.
EB

Elizabeth Breen, MD

Retired surgeon. Clinical resesrcher
Lahey Hospital and Medical Center
Cambridge, Massachusetts, United States

Disclosure information not submitted.
JC

Jonathan J. Canete, MD

Associate Professor of Surgery
Albany Medical Center
Albany, New York, United States

Disclosure information not submitted.
Christy Cauley, MD, MPH (she/her/hers)

Associate Professor
Mass General Brigham
Massachusetts General Brigham; Harvard Medical School
Winchester, Massachusetts, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.
AC

Alexandra Columbus, MD MPH

Staff Surgeon
Emerson Hospital
Concord, Massachusetts, United States

Disclosure information not submitted.
JD

Jeremy Dressler, MD

Assistant Professor
University of Vermont Department of Surgery
Burlington, Vermont, United States

Disclosure information not submitted.
Robert N. Goldstone, MD

Assistant Professor of Surgery
Massachusetts General Hospital
Harvard Medical School
Boston, MA, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.
David A. Kleiman, MD, MSc, FACS, FASCRS (he/him/his)

Staff Surgeon
Lahey Hospital & Medical Center
Lahey Hospital & Medical Center
Melrose, MA, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.
AK

Angela H. Kuhnen, MD, MPH (she/her/hers)

Attending
Lahey Hospital and Medical Center
Tufts University School of Medicine
Burlington, Massachusetts, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.
Grace C. Lee, MD

Assistant Professor of Surgery
Massachusetts General Hospital
Harvard Medical School
Boston, MA, United States

Disclosure information not submitted.
Ira L. Leeds, MD

Asst Prof of Surgery
Yale School of Medicine
New Haven, CT, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.
RL

Robert T. Lewis, MD (he/him/his)

Program Director, Saint Francis Hospital
Colon and Rectal Surgeons of Greater Hartford
Saint Francis Hospital and Medical Center
Bloomfield, CT, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
JM

Joseph Mack, MD

Colorectal Surgeon
Maine Medical Center
Portland, Maine, United States

Disclosure information not submitted.
Peter W. Marcello, MD, FACS, FASCRS (he/him/his)

Chair, Division of Colon & Rectal Surgery
Lahey Hospital & Medical Center
Burlington, Massachusetts, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.
DM

Daniel Mullins, M.D.

Colon and Rectal Surgeon
Saint Francis Hospital
Hartford, Connecticut, United States

Disclosure information not submitted.
MM

Melissa Murphy, MD

Executive Chief of Surgery
Brigham and Women's Hospital
Boston, Massachusetts, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
Haddon J. Pantel, MD

Assistant Professor
Yale School of Medicine
Yale School of Medicine
New Haven, CT, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.
AR

Andrew C. Raissis, MD

Colorectal Surgeon faculty
Andrew Raissis
West Hartford, Connecticut, United States

Disclosure information not submitted.
RS

Rachel B. Scott, DO (she/her/hers)

Chief of Colon and Rectal Surgery St. Francis Hospital
Colon and Rectal Surgeons of Greater Hartford
St. Francis Hospital and Medical Center
West Hartford, CT, United States

Disclosure information not submitted.

Abstract Podium Presenter(s)

Julia Saraidaridis, MD, MMSc

Staff Surgeon
Lahey Hospital and Medical Center
Tufts University School of Medicine
Burlington, MA, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Purpose/Background: The current American Society of Colon and Rectal Surgeons clinical practice guidelines for chronic anal fissure provide no consensus on the use of botulinum toxin type A versus lateral internal sphincterotomy (LIS) resulting in wide variation in practice. This quality improvement project aimed to clarify the current practice patterns among New England colorectal surgeons using botulinum toxin injection and LIS for treatment of chronic anal fissure and report associated patient outcomes.

Methods/Interventions: This was a prospective, quality-improvement registry of surgeon-reported data open to all colon and rectal surgeons in New England performing botulinum toxin injection or LIS for treatment of chronic anal fissure. Collected variables included patient demographics, presenting symptoms, preoperative functional assessment, physical exam findings, operative findings, postoperative functional assessment, and postoperative satisfaction.

Results/Outcomes: 201 patient records were submitted from 23 providers across 13 centers. 158 underwent botulinum toxin injection and 41 LIS. There was no difference in demographic characteristics between the groups. Patients who underwent LIS had higher mean preoperative pain scores (7 vs. 5;p < 0.01).
Most (85%) botulinum toxin procedures were performed in the operating room. 60% were done under monitored anesthesia care, 21% under general anesthesia, and 10% with no anesthesia. Median botulinum toxin unit injection was 100 units (range 50-200 units). The median concentration was 33 units/mL (range 25-200 units/mL). Injection techniques varied with 51% into the internal sphincter and 37% into the inter-sphincteric groove. 45% underwent concomitant procedures along with botulinum injection including tag excision, fissure debridement, hemorrhoidectomy, and hemorrhoid banding. The majority of LIS were performed in a tailored fashion (90%) and 56% were performed open.
Median follow-up time was 31 days (IQR 28 - 41 days). The LIS group had superior resolution of bleeding (68% vs. 45%;p =0.02) and a decreased need for further procedures (2% vs. 24%;p < 0.01) in comparison to botulinum injection. LIS also had a greater reduction in pain scores post-operatively (5 vs. 3;p < 0.01) and higher mean satisfaction with treatment score (9 vs. 7;p < 0.001). Postoperative mean Vaizey incontinence scores improved in the LIS group (mean change -0.9) but worsened slightly in the botulinum toxin group (mean change 0.7;p = 0.05).

Conclusion/Discussion: While both LIS and botulinum toxin provided symptom relief for chronic anal fissure, LIS was associated with superior symptom resolution, greater pain reduction, and higher patient satisfaction. Both techniques had minimal change to continence. These results support the use of LIS in appropriately selected patients. Importantly, this initiative demonstrates the strength of a regional, multi-institutional quality collaborative in generating meaningful, real-world data to inform practice.

Figure 1: Change in Mean Pain Scores Before and After Treatment Specified by Treatment Type