Decoding the Risks of Fecal Incontinence: A Comprehensive Analysis of Closed Internal Sphincterotomy in Chronic Anal Fissure

Introduction An anal fissure is marked by a longitudinal tear in the mucosal lining of the lower anal canal, causing painful defecation and mild anal bleeding. The classical triad includes an anal ulcer, a sentinel tag, and a hypertrophic papilla. This study investigates the frequency of fecal incontinence in patients with anal fissure undergoing closed internal sphincterotomy, offering recent insights for treatment recommendations. Objective To determine the prevalence of fecal incontinence in individuals with chronic anal fissure undergoing closed internal sphincterotomy. Methodology The study design was a descriptive case series, conducted over a 6-month period (August 21, 2018 to February 21, 2019). It was carried out at the General Surgery Department, Lady Reading Hospital MTI, Peshawar, Pakistan. The participants included a total of 139 patients diagnosed with chronic anal fissures. Data collection To gather comprehensive information, a detailed approach was adopted. This included history taking, general physical examinations, and digital rectal examinations for all patients. All patients diagnosed with chronic anal fissure were prepared for lateral internal sphincterotomy (LIS). Variables The variable of interest was the occurrence of fecal incontinence, assessed during follow-up visits at the end of the 2nd and 6th week post-surgery. Ethical consideration The study received approval from the hospital's ethical committee and the College of Physicians and Surgeons of Pakistan (CPSP) research committee. Results In our study, the mean age was 30 years (SD ± 12.16). Forty-five percent of patients were male, and 55% were female. Fecal incontinence was observed in 10% of patients. Conclusion Our study reveals a fecal incontinence frequency of 10% in patients undergoing closed LIS for chronic anal fissure.