Safety and efficacy of the treatment of chronic anal fissure by lateral internal sphincterotomy: A retrospective cohort study

Abstract

Background An anal fissure is one of the most common anorectal diseases resulting from a longitudinal tear in anoderm under the dentate line. It causes severe pain during defecation, and the resulting emotional stress leads to a reduction in the overall quality of life of a person. There are several medical and surgical treatment procedures that are employed to treat anal fissures. In the present retrospective study, we aimed to evaluate the safety and efficacy of lateral internal sphincterotomy (LIS) surgical procedure for the treatment of chronic anal fissure. Additionally, we also analyzed the complications arising after the surgery and the factors affecting the complications. Methods The present study is a retrospective study that included 691 patients treated for chronic anal fissure in a private sector setting, by a single Saudi female surgeon, starting from April 2004 to April 2020. Results Out of the 691 patients included in the study, all the patients were female, with an average age of 45.77 years (ranging from 17 to 82 years). Major complaints of the patients were as follows: pain, bleeding, constipation, pruritus, perianal discharge. Recurrence was reported in 2 patients (0.3%) while, 3 patients (0.4%) developed gas incontinence.The complaints of all patients with gas incontinence regressed over a period of time. Conclusion This study reports that lateral internal sphincterotomy (LIS) is a safe surgical treatment for chronic anal fissure, leading to a reduction in recurrence, incontinence rate and substantially improves symptoms, especially pain.

Lateral Internal Anal Sphincterotomy of Chronic Anal Fissure: An Experience of 165 Cases

“…Incontinence to gas and stool has emerged as a major concern after sphincterotomy [ 1 ]. Incontinence rates of up to 14% have been reported, but these vary widely among studies [ 13 ]. Much of this variation can be attributed to differences in definition and assiduousness of follow-up.…”

Comparison of Botulinum Toxin (BoNT) Injection and Lateral Internal Sphincterotomy (redo-LIS) for Recurrent Anal Fissure Treatment

“…Our study demonstrates that, at the clinics experienced in proctology, the most dreaded risk of incontinence following redo-LIS is at acceptable levels at the early phase and returns to normal at the end of 3rd month. Its rates were reported in the literature as 0.4-35% [23,24].…”

Comparison of botulinum toxin (BoNT) injection and lateral internal sphincterotomy (redo-LIS) for recurrent anal fissure treatment

“…Our study demonstrates that, at the clinics experienced in proctology, the most dreaded risk of incontinence following redo-LIS is at acceptable levels at the early phase and returns to normal at the end of 3rd month. Its rates were reported in the literature as 0.4% to 35% ( 23 , 24 ).…”