Lateral Internal Sphincterotomy for Fissure in Ano: A Retrospective Long-Term Review

Anal fissure is a common benign disease which affects patient’s quality of life. Lateral internal sphincterotomy is a routine surgical treatment for it, but it has been reported to have long term recurrence and incontinence. Even though many studies are available in this subject, long term studies spanning over a decade is uncommon. In this case series analysis, the historical patient records of those who underwent lateral internal sphincterotomy in the last 10 years was analyzed, patients were contacted telephonically and information was recorded. A total of 306 patients were analyzed. In the post-op period 3.9% of patients had incontinence to flatus and 2% had incontinence to liquid feces which improved over 4-8 weeks. 8.8% of patients had recurrence. There were no wound related post op complications. None had long term incontinence. 88.6% were highly satisfied by the surgery. Female patients exhibited higher satisfaction (95.7%) and a lower recurrence rate (2.1%). Patients in the 18-30 age group demonstrated lower recurrence rates (4.5%) when compared to >60 years (50%). Recurrent episodes of constipation in the post-surgery period were strongly associated with a high fissure recurrence rate. Lateral internal sphincterotomy is a valuable surgery providing adequate pain relief, high healing rates, low complications, low recurrence rates and high patient satisfaction. Key words: Anal fissure; Lateral internal sphincterotomy; Fecal Incontinence; Constipation.