Controlled lateral sphincterotomy for chronic anal fissure

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Chronic anal fissures are a common anorectal condition often treated with lateral internal sphincterotomy.
• Traditional lateral internal sphincterotomy carries a risk of postoperative incontinence, particularly in patients with anal stenosis.
• Anal stenosis, a narrowing of the anal canal, can complicate surgical outcomes and patient recovery.

Purpose of the Study:

• To evaluate the efficacy and safety of a novel "controlled" lateral sphincterotomy technique for chronic anal fissures.
• To compare the incidence of incontinence and recurrence rates between controlled and traditional sphincterotomy.
• To assess the utility of a new conical calibrator for quantifying anal stenosis.

Main Methods:

• A comparative study involving 225 patients with chronic anal fissures.
• 110 patients underwent traditional sphincterotomy, while 115 received controlled sphincterotomy in three graded steps based on anal stenosis severity.
• Anal stenosis was objectively measured using a calibrated conical device under anesthesia; patient-reported outcomes were collected via telephone follow-up.

Main Results:

• Controlled sphincterotomy resulted in significantly lower rates of minor incontinence (2% vs. 10%, P = 0.017) compared to traditional methods.
• No patients undergoing controlled sphincterotomy reported fecal incontinence or leakage, while one recurrence was noted in the traditional group.
• The majority (78%) of controlled sphincterotomies were performed below the dentate line, indicating a more conservative approach.

Conclusions:

• Controlled lateral sphincterotomy is an effective modification that minimizes the risk of incontinence associated with lateral internal sphincterotomy for chronic anal fissures.
• This technique offers a promising approach to managing anal fissures, especially in the presence of anal stenosis, by tailoring the sphincterotomy depth.
• The use of objective measurements for anal stenosis aids in guiding the surgical approach and potentially improving functional outcomes.