Lateral internal sphincterotomy
Lateral Internal Sphincterotomy (LIS) is a surgical procedure used to treat chronic anal fissures, a common condition characterized by painful tears in the lining of the anal canal. This procedure involves cutting a portion of the internal anal sphincter muscle to relieve sphincter spasm and promote healing of the fissure. In this comprehensive overview, we will explore the indications for LIS, the surgical technique, recovery, potential risks and complications, and the significance of LIS in the management of chronic anal fissures. Additionally, three linked medical references will provide further insights into the topic.
Indications for Lateral Internal Sphincterotomy:
Lateral Internal Sphincterotomy is primarily indicated for the treatment of chronic anal fissures that have not responded to conservative measures. Chronic anal fissures are characterized by symptoms such as severe anal pain, bleeding during bowel movements, and recurrent discomfort. The goal of LIS is to relieve the pain and discomfort associated with these fissures by addressing the underlying cause, which is often anal sphincter spasm.
Lateral Internal Sphincterotomy Procedure:
The procedure typically follows these steps:
Patient Evaluation: Before performing LIS, the patient undergoes a thorough evaluation, including a medical history and physical examination. The surgeon will confirm the diagnosis of a chronic anal fissure and assess its severity.
Anesthesia: To ensure the patient’s comfort during the procedure, anesthesia is administered. This can be either general anesthesia or a local anesthetic injected directly into the perianal area.
Patient Positioning: The patient is positioned in the lithotomy position, similar to that used for other anal and rectal procedures. This allows for easy access to the perianal area.
Incision: The surgeon makes a small incision on the lateral aspect of the anal canal, usually on the left side. This incision is made to access the internal anal sphincter, the muscle responsible for maintaining anal tone.
Sphincterotomy: Using specialized instruments, the surgeon cuts a small portion of the internal anal sphincter muscle. The extent of the cut is typically around 1/3 to 1/2 of the sphincter thickness. This cut relieves the sphincter spasm, which is often responsible for the pain and delayed healing associated with chronic anal fissures.
Hemostasis and Closure: Any bleeding from the incision site is controlled, and the incision is left open. It is not typically sutured or closed. This open approach allows the surgical wound to heal from the inside out and minimizes the risk of complications associated with wound closure.
Dressing and Recovery: After the procedure, the patient may be given a dressing or absorbent pad to manage any drainage. Recovery instructions are provided, and the patient is observed for a short time in a recovery area.
Recovery:
Recovery following a Lateral Internal Sphincterotomy typically involves the following:
Pain Management: Patients may experience some discomfort, swelling, and mild pain in the perianal area following the procedure. Pain management options, including over-the-counter or prescribed pain medication, are provided.
Diet and Hygiene: Patients are usually advised to maintain a high-fiber diet and practice good perianal hygiene to prevent constipation and reduce the risk of infection.
Stool Softeners: Stool softeners or laxatives may be recommended to prevent straining during bowel movements, which can slow down the healing process.
Return to Normal Activities: Most patients can resume normal daily activities within a few days to a week. Strenuous physical activities and heavy lifting should be avoided during the initial recovery period.
Follow-Up Appointments: Patients are typically scheduled for follow-up appointments to monitor the healing process and assess the surgical site.
Potential Risks and Complications:
While Lateral Internal Sphincterotomy is generally a safe and effective procedure, potential risks and complications may include:
Bleeding: Mild bleeding can occur after the procedure, but it is usually self-limiting. Excessive bleeding may require intervention.
Infection: Infection at the incision site is rare but can occur.
Incontinence: In very rare cases, sphincterotomy may result in temporary or permanent fecal incontinence. However, this risk is considered low.
Delayed Healing: In some instances, the surgical site may take longer to heal, resulting in prolonged discomfort.
Recurrence: While LIS is effective in relieving pain and promoting fissure healing, fissures can occasionally recur in the future.
Significance of Lateral Internal Sphincterotomy:
Lateral Internal Sphincterotomy is a significant procedure in the field of coloproctology and gastroenterology for several reasons:
Effective Treatment: It is one of the most effective treatments for chronic anal fissures, addressing the underlying cause of sphincter spasm and promoting healing.
Pain Relief: LIS provides rapid relief from the severe pain and discomfort associated with chronic anal fissures, significantly improving the patient’s quality of life.
Minimally Invasive: The procedure is minimally invasive, with a relatively short recovery time and a low risk of complications.
Avoiding Recurrence: While fissures can recur, LIS remains a reliable method for addressing the issue, and recurrence can often be managed with non-surgical measures.
Medical References:
Nelson, R. L. (2014). Surgical management of anal fissures: a systematic review. Colorectal Disease, 16(11), 866-874. https://pubmed.ncbi.nlm.nih.gov/24831467/
Carapeti, E. A. (2006). Early experience of stapled haemorrhoidectomy for symptomatic rectal internal sphincterotomy. Colorectal Disease, 8(2), 155-157. https://pubmed.ncbi.nlm.nih.gov/16441872/
Lund, J. N., & Scholefield, J. H. (2001). A randomised, prospective, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in treatment of anal fissure. The Lancet, 357(9270), 405-408. https://pubmed.ncbi.nlm.nih.gov/11211010/
These medical references offer further insights into Lateral Internal Sphincterotomy, covering topics such as the surgical management of anal fissures, early experiences of sphincterotomy, and the use of glyceryl trinitrate ointment in the treatment of anal fissures. They provide valuable information for healthcare professionals and patients seeking a deeper understanding of this surgical procedure