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Total lateral sphincterotomy for anal fissure.
Adriano Tocchi1, Gianluca Mazzoni, Michelangelo Miccini
1First Department of Surgery, Medical School, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy. adriano.tocchi@uniroma1.it
International Journal of Colorectal Disease
|September 19, 2003
Summary
Total subcutaneous internal sphincterotomy effectively treats chronic anal fissures with high patient satisfaction. This surgical approach for anal fissure offers a safe and effective solution, minimizing recurrence and long-term complications.
Area of Science:
- Colorectal Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Previous posterior sphincterotomy for anal fissures yielded unsatisfactory results, including high recurrence and incontinence rates.
- A novel lateral approach for complete internal sphincter section was developed to address these limitations.
Purpose of the Study:
- To evaluate the safety and efficacy of a lateral approach for total subcutaneous internal sphincterotomy in treating chronic anal fissures.
- To assess postoperative outcomes, including healing rates, complications, and patient satisfaction.
Main Methods:
- Surgical treatment of 164 patients with anal fissure between 1997 and 2001 using the lateral approach.
- Preoperative and postoperative anal manometries were performed.
- Postoperative course, early, and long-term results were meticulously recorded.
Main Results:
- All 164 fissures healed successfully, with no treatment failures.
- Early complications included bleeding, hematoma, and pain.
- Transient incontinence occurred in 15 patients; persistent incontinence to flatus and soiling was observed in 5 patients.
- No long-term complications were noted post-total sphincterotomy.
- Patient satisfaction rate reached 96%.
Conclusions:
- Total subcutaneous internal sphincterotomy is a safe and effective surgical procedure for chronic anal fissures.
- The lateral approach demonstrates a high success rate with acceptable complication profiles.