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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
PubMed
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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.

Related Experiment Videos

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.