Long–term assessment of fecal incontinence after lateral internal sphincterotomy (original) (raw)
Related papers
Morbidity of internal sphincterotomy for anal fissure and stenosis
Diseases of The Colon & Rectum, 1985
Internal sphincterotomy is thought by most surgeons to have minimal complications. We retrospectively reviewed 306 patients following internal sphincterotomy to determine the incidence of any complications. Major complications (requiring reoperation) caused by fistula, bleeding, abscess, or unhealed wounds occurred in ten patients (3 percent). Minor complications caused by pruritus, persistent wound, pain, bleeding, abscess, discharge, urgency, impaction, or defects of continence occurred in 110 patients (36 percent). Complications were lowest for closed sphincterotomy (20 percent) and highest for open sphincterotomy alone (55 percent). All patients were cured of anal fissure or stenosis. Long-term follow-up (average 4.3 years) revealed a 22 percent incidence of persistent minor complications. Defects in continence caused 15 percent of total long-term morbidity. Minor complications occur frequently after internal sphincterotomy for anal fissure and stenosis. Closed sphincterotomy has the lowest complication rate. Long-term minor defects in continence occur in a significant number of patients.
Results following conservative lateral sphincteromy for the treatment of chronic anal fissures
Colorectal Disease, 2003
Introduction Lateral sphincterotomy is now the standard surgical treatment for fissure-in-ano. Healing is achieved in 90% of cases, however, sphincterotomy also carries a significant risk of incontinence. Traditional sphincterotomy comprises of division of the internal sphincter up to the level of the dentate line, a more conservative division could lead to a lower incontinence rate, with an equivalent healing rate.
International Journal of Surgery Science
Background: Fissure in ano is a tear in the anoderm distal to the dentate line. Surgical techniques for management of chronic anal fissure are Lords anal dilatation (LAD) and Lateral internal sphincterotomy (LIS). The aim of this study is to compare the symptoms, post-operative complications and recurrence risk of the above two techniques. Methods: It was a prospective, randomized controlled trial done in department of General Surgery, ESIC Medical College, Kalaburagi from June 2016-May 2017. A total of 80 patients lined up for surgical management of chronic anal fissure were divided into two groups (40 each). In group A, 40 patients underwent LAD and in group B, 40 underwent LIS. Patients were followed up for 6 months following surgery for pain, bleeding, incontinence, post-operative hospital stay and recurrence. Wong Baker scale, Modified Longo score and Wexner scales were used for assessment of pain, constipation and incontinence respectively. Various post-operative symptoms, complications and recurrence risk were evaluated post operatively at 24 hours, before discharge from the hospital, 1st, 3rd and 6th months of operation respectively. Results: Male female ratio was 1:1.8. Most common presenting complaint was pain seen in 97% patients. Sentinel tag at 6 o'clock position was seen in the majority (90%) patients on presentation. Except for pain score, which was statistically more significant at 24 hours postoperatively in the LAD group (p=0.012), recurrence is there was no statistical difference between the two groups when compared at different points of evaluation for symptoms, complications and recurrence (p=0.565). Conclusions: With minor difference in pain, Lord's dilatation compared to sphincterotomy, since there were no findings of incontinence, or situations which resulted in sphincter damage, we conclude that LAD is suitable for patients with chronic anal fissures because it is less invasive than LIS, with equivalent efficacy and safety.
Faecal incontinence after internal sphincterotomy for anal fissure
Techniques in Coloproctology, 2000
Minor defects in continence following open lateral sphincterotomy are relatively common. This study prospectively assessed 28 patients undergoing lateral sphincterotomy for chronic anal fissure. There were substantial differences in both resting and squeeze anal pressures and vector volumes in the incontinent cohort when compared to the continent post-operative cases. Mean preoperative high pressure zone was 37.6 mm, significantly higher than the postoperative value of 17.0 mm (p < 0.001). There was a significant difference in percent asymmetry of the anal canal at rest between incontinent and continent post-sphincterotomy cases, with a 6.7% increase in the former group and a 3.1% fall in the latter group (p < 0.001). It is unknown whether these changes are predictive for longterm continence.
International Journal of Colorectal Disease, 1987
Twenty patients with chronic anal fissure were randomized into two groups. Ten patients were treated with lateral subcutaneous sphincterotomy and 10 with anal dilatation. Anal dilatation was carried out preoperatively, and at 1 and 3 months after the operation in all patients. Preoperatively there was a significantly increased maximal resting pressure in the 20 fissure patients (80 mmHg median) compared with 20 control subjects (50mmHg median). Postoperatively a significant decrease in pressure occurred in the dilated group (49 mmHg median p<0.05), whereas the pressure was not significantly reduced in the group that underwent sphincterotomy (65 mmHg median p <0.05). At 1 year three patients complained of recurrent symptoms of anal fissure in the dilated group compared with one in the sphincterotomy group. Minor continence disturbance was noted in two patients in both groups.
Sphincterotomy is the Gold-Standard Treatment of Chronic Anal Fissure: But How Should it be Done?
IntechOpen eBooks, 2023
A chronic anal fissure is one of the most encountered anorectal diseases in the clinical practice of general surgery. After all the medical therapies have failed, lateral internal sphincterotomy is still the mainstay treatment for chronic anal fissure. The optimal and standardized sphincterotomy has the utmost importance in preventing postoperative incontinence and recurrence, which are consequences of either extreme or insufficient sphincterotomy. Therefore, the lateral internal sphincterotomy technique has been evolved within years with the initial proposition of controlled-sphincterotomy and improvement of this technique with the addition of sphincterotomy up to the dentate line. This chapter focuses on the chronic anal fissure in the era of spasm-controlled lateral internal sphincterotomy.
Efficacy and safety of subcutaneous lateral internal sphincterotomy for chronic anal fissure
Journal of Ayub Medical College, Abbottabad : JAMC
This study was undertaken to determine the efficacy and safety of subcutaneous lateral internal sphincterotomy (SLIS) for chronic anal fissure by assessing the relief of defecatory pain, duration of wound healing and associated complications such as bleeding, infection, and anal incontinence. This descriptive case series was carried out at the Department of Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from September 1, 2008 to February 28, 2009. Out of fifty patients 31 were males and 19 were females. The mean age was 30.04 ± 8.49 years. Defecatory pain and bleeding per rectum were the commonest symptoms, found among all patients. Symptomatic relief of pain following surgery was observed among all patients at 4th week while all fissures healed at 8th week. At 4th weeks follow-up visit none of the patients had flatus incontinence while at 8th weeks all patients had good faecal continence. Majority (76%) of the patients were managed as Day case or Extended day cas...
BMC Surgery, 2021
Introduction Lateral internal sphincterotomy (LIS) is still the approach of choice for the treatment of chronic anal fissure (CAF) regardless to the internal anal sphincter tone but it is burdened by high risk post-operative faecal incontinence (FI). In female patient there are some anatomical and functional differences of the sphinteric system which make them more at risk of FI and vaginal birth could cause sphinteric lesions affecting the anal continence function. The aim of our study is to evaluate the results of saving sphincter procedure as treatment for female patients affected by CAF. Methods We studied 110 female patients affected by CAF undergone fissurectomy and anoplasty with V–Y cutaneous flap advancement associating pharmacological sphincterotomy in patients with hypertonic IAS. The follow up was at least for 2 years. The goals were patient’s complete healing, the evaluation of FI, recurrence rate and manometry parameters. Results All wounds healed within 40 days after ...
Lateral Internal Partial Sphincterotomy Technique for Chronic Anal Fissure
Lateral internal sphincterotomy is used for the treatment of a chronic anal fissure. There is a lack of consensus for the amount of internal sphincter division necessary in the surgical treatment of an anal fissure. The anatomy of the anal sphincters and the subcutaneous partial sphincterotomy technique are presented with fresh anal canal specimen photographs. Lateral internal partial sphincterotomy is performed in 43 patients in the office between 2012 and 2013. The patients were questioned about their bowel habitus and any problem with anal control before the operation. Postoperatively, the patients were followed up by office visits and telephone calls at 1 week, 1 month, and 6 months. Data were collected prospectively. Forty of the patients (93 %) were pain free in 1 week after the operation. Further sphincter fibers were divided in three patients (7 %) because of the persistent pain. The most common complication was the sensation of burning (n = 9, 20.9 %) around the anus. Bleeding in three patients, itching around the anus in two patients, and incontinence to flatus in one patient were the other complications. None of the patients developed fecal incontinence in the follow-up period. Lateral internal partial sphincterotomy is a safe, effective, and reproducible technique for the management of chronic anal fissure pain.
Techniques in Coloproctology, 2023
Purpose The standard treatment for chronic anal fissures that have failed non-operative management is lateral internal sphincterotomy. Surgery can cause de novo incontinence. Fissurectomy has been proposed as a sphincter/saving procedure, especially in the presence of a deep posterior pouch with or without a crypt infection. This study investigated whether fissurectomy offers a benefit in terms of de novo post-operative incontinence. Methods Patients surgically managed with fissurectomy or lateral internal sphincterotomy for chronic anal fissures from 2013 to 2019 have been included. Healing rate, changes in continence and patient satisfaction were investigated at long-term follow-up. Results One hundred twenty patients (55 females, 65 males) were analysed: 29 patients underwent fissurectomy and 91 lateral internal sphincterotomy. Mean follow-up was 55 months [confidence interval (CI) 5-116 months]. Both techniques showed some rate of de novo post-operative incontinence (> +3 Vaizey score points): 8.9% lateral internal sphincterotomy, 17.8% fissurectomy (p = 0.338). The mean Vaizey score in these patients was 10.37 [standard deviation (sd) 6.3] after lateral internal sphincterotomy (LIS) and 5.4 (sd 2.3) after fissurectomy Healing rate was 97.8% in the lateral internal sphincterotomy group and 75.8% in the fissurectomy group (p = 0.001). In the lateral internal sphincterotomy group, patients with de novo post-op incontinence showed a statistically significant lower satisfaction rate (9.2 ± 1.57 versus 6.13 ± 3; p = 0.023) while no differences were present in the fissurectomy group (8.87 ± 1.69 versus 7.4 ± 1.14; p = 0.077). Conclusions Lateral internal sphincterotomy is confirmed as the preferred technique in term of healing rate. Fissurectomy did not offer a lower rate of de novo post-operative incontinence, but resulted in lower Vaizey scores in patients in whom this occurred. Satisfaction was lower in patients suffering a de novo post-operative incontinence after lateral internal sphincterotomy.