Results of Lateral Internal Sphincterotomy with Open Technique for Chronic Anal Fissure: Evaluation of Complications, Symptom Relief, and Incontinence with Long-Term Follow-Up

Abstract

The aim of this study is to investigate the results of open lateral internal sphincterotomy (LIS) and the recurrence and incontinence rate, to perform a long-term assessment of incontinence and to assess complications and relief of symptoms. This clinical prospective study was undertaken in patients undergoing open LIS. One hundred and twenty-nine patients entered the study. Mean duration of pain relief was 1.2 +/- 0.4 days and mean time before defecation without pain was 1.9 +/- 1.0 days. Complication rate was 41.8%. We found that urine retention was seen frequently in males. We demonstrated that open LIS up to the dentate line does not have a higher rate of incontinence. Incontinence after LIS was only to flatus and two-thirds of these resolved in 6 weeks. No patient showed improvement of incontinence after 6 weeks.

Conservative and Surgical Treatment of Chronic Anal Fissure: Prospective Longer Term Results

“…35 Although the proximal extent of the LIS continues to be a topic of debate, in our experience, by "tailoring" the amount of sphincter to be divided to the length of the fissure, the risk of incontinence is minimized as well as the fissure healing achieved.…”

“…33,34 Nonetheless, in addition to continence disturbance, general surgical complication rates range from 7% to 42% mostly related to hemorrhage, abscess, fistula, fecal impaction, and urinary retention. 35 In the late 1990s, alternatives to surgery were sought because of risk of incontinence, complications, costs, and recovery time. These included nitroglycerin ointment, calcium channel blockers, and botulinum toxin injection.…”

“…The proximal extent of LIS up to the apex of fissure, although associated with a delayed healing and increased recurrences, 16,35,61 minimizes the risk of continence disturbance. Proximal extent of LIS is particularly important in female patients because of the shorter length of the internal sphincter and vaginal deliveries that have been found to a be a significant risk factor of incontinence after LIS.…”

The Long-term Effect of Standardized Anal Dilatation for Chronic Anal Fissure on Anal Continence

“…Although the procedure of lateral internal sphincterotomy is widely accepted as the gold standard approach for anal fissure, it is not perfect in the long run in terms of continence. In addition to late imperfection of anal function that could be related to aging and other risk factors, the lateral internal sphincterotomy has its own low but not negligible rate of up to 4% of septic or wound-related complications (postoperative cellulitis, bleeding/hematoma, abscess formation and wound infection) requiring additional interventions, and up to 18% of urine retention demanding catheterization [28][29][30].…”

Medical and surgical treatment of haemorrhoids and anal fissure in Crohn’s disease: a critical appraisal

“…However more than half of the patients developed some complications after surgery, mainly difficulties in wound healing, confirming the higher risk compared to the general population. Indeed in literature complication rates range from 7% to 42%, and in our experience in unaffected subjects, it is about 10% [28,29]. …”