Lateral internal sphincterotomy for fissure-in-ano - Revisited

PURPOSE: A disturbing complication rate following lateral internal sphincterotomy (LIS) has recently been reported, and this study assessed our complication rate. METHODS: Charts of 312 patients who were operated on between January 1975 and December 1993 were reviewed. RESULTS: There were 148 men (47.5 percent) and 164 women (52.5 percent), ranging in age from 16 to 95 (mean, 40) years. Two hundred sixty-five patients underwent LIS as a primary and sole procedure. Mean follow-up time was 20.4 months (range, 2 weeks-215 months). Healing times were less than one month (11.6 percent), one month (73.2 percent), one to two months (9.6 percent), and more than two months, 5.6 percent. Twenty-three complications (8.7 percent) occurred in 20 (7.5 percent) of the 265 patients: delayed healing (>60 days) of the sphincterotomy site (13); persistence or recurrence of the fissure (3); wound infection (2); incontinence to flatus (1); soiling (1); temporary incontinence to flatus and stool (1); prolapsed hemorrhoids (1); fecal impaction (1). Most complications were minor and resolved spontaneously. Reoperations included one revision and one hemorrhoidectomy. CONCLUSIONS: This review supports the belief that LIS is a good operation for patients with chronic anal fissure and can successfully be performed under local anesthetic as an outpatient procedure with an acceptable complication rate.