Mild and Severe Anal Incontinence after Lateral Internal Sphincterotomy: Risk Factors, Postoperative Anatomical Findings and Quality of Life

Abstract

Aim: This study aims to evaluate the risk factors for incontinence after lateral internal sphincterotomy (LIS) and assess quality of life in different levels of incontinence. Methods: All consecutive patients (n = 253) with chronic anal fissure who underwent LIS between 2003 and 2006 were retrospectively reviewed. All patients were questioned for possible anal incontinence according to the Wexner Incontinence Score (WIS). Demographics, vaginal delivery history, additional procedures and surgeon’s experience were evaluated as risk factors. Endoanal ultrasound (EUS) was performed in incontinent patients to assess the thickness of the remaining internal sphincter and to evaluate any injury in the external sphincter. Quality of life was questioned with SF-36. Results: Twenty-eight (11.7%) patients suffered from incontinence (mean WIS = 3.6 ± 2.5). The search for a risk factor was unsuccessful when continent and incontinent groups were compared. In subgroup analyses, patients were found to be suffering from mild (WIS <5, n = 19) or severe (WIS >5, n = 9) incontinence. Vaginal delivery history was found more often in the severely incontinent subgroup than in the continent group (p < 0.05). Also, vaginal delivery history and the additional procedures were more frequently observed in the severely incontinent subgroup than in the mildly incontinent subgroup. EUS did not find any external sphincter injury in these cases. WIS had negative correlations with the physical and mental component scores of SF-36. Conclusion: In our opinion, the threat for incontinence is unpredictable; however, vaginal delivery history may increase the risk of severe incontinence.

The effect of lateral internal sphincterotomy on resting anal sphincter pressures*

“…Incontinence remains the main distressing complication after the operation. Flatus incontinence occurred in 3 (7.31%) patients after the operation, similar to previous studies (6,25).…”

“…Although a decrease in anal sphincteric pressure is the desired outcome of the procedure, an incompetent anal sphincter complex may result in anal incontinence. Thus, the amount of decrease in anal sphincteric pressure after surgical sphincterotomy is critical (6). This study investigated changes in anal sphincteric resting pressures after LIS, which was performed for chronic anal fissure treatment.…”

Surgical complications and their impact on patients’ psychosocial well-being: a systematic review and meta-analysis

“…QoL was the main reported psychosocial outcome. Three studies measured anxiety, 30 40 62 four studies measured depression 31 41 49 62 and one study measured mood states. 41 No other psychosocial outcomes were measured.…”

“…Points were deducted for the following reasons: lack of information on how complications were defined or on the methods for their recording, 16–18 21–23 25 29 35 37 40–42 46 51 55–57 61 63 lack of information on response rates, 16 21 22 25–27 29 37 40 50 52 54 55 57 60 61 baseline psychosocial outcomes were either not measured or controlled for, 17 19 20 25 27 30–36 38–40 43–45 47 49 53 63 and demographic or clinical factors were not controlled for. 20 25 27 31 32 34 40 43 45 51 56 61 63 Seven studies scored exceptionally low (ie, below 4).…”

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“…It had been found that incontinence following lateral sphincterotomy is transient and this is may be attributed to the increased tone of the internal sphincter indicating recovery of the sphincter after operation [7,10,16,17]. The high percentage of incontinence following lateral sphincterotomy in some adult series may be attributed to older aged patients, multiparous women and additional or previous anal surgery [18,19].…”