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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Incontinence after a lateral internal sphincterotomy: are we underestimating it?
Sergio Casillas1, Tracy L Hull, Massarat Zutshi
1Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Diseases of the Colon and Rectum
|May 21, 2005
Summary
Sphincterotomy for chronic anal fissures may lead to long-term flatal incontinence, especially in females with multiple vaginal deliveries. Recurrence rates were higher with office-based procedures and local anesthesia.
Area of Science:
- Colorectal surgery
- Gastroenterology
- Patient outcomes research
Background:
- Chronic anal fissures are a common condition.
- Lateral internal sphincterotomy is a standard surgical treatment.
- Long-term outcomes and quality of life after this procedure require further investigation.
Purpose of the Study:
- To assess long-term outcomes and quality of life in patients after sphincterotomy for chronic anal fissure.
- To identify factors associated with recurrence and incontinence.
Main Methods:
- Retrospective review of medical records (1992-2001).
- Postal survey assessing current status, quality of life, and incontinence severity.
- Analysis of recurrence rates and associated factors.
Main Results:
- Sphincterotomy recurrence occurred in 5.6% of patients, higher with office procedures and local anesthesia.
- Flatal incontinence was significantly underreported in medical records compared to survey responses.
- 30% of patients experienced persistent flatal incontinence, particularly females with multiple vaginal deliveries.
Conclusions:
- Lateral internal sphincterotomy recurrence may be linked to local anesthesia or office procedures.
- Female patients with multiple vaginal deliveries should be counseled on potential flatal incontinence risks.
- Long-term flatal incontinence can occur in up to one-third of patients and may be permanent.
