Lateral Internal Partial Sphincterotomy Technique for Chronic Anal Fissure.

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Surgical Anatomy

Background:

• Chronic anal fissures often require surgical intervention.
• There is ongoing debate regarding the optimal extent of internal sphincter division for effective treatment.
• Understanding anal sphincter anatomy is crucial for surgical success.

Purpose of the Study:

• To evaluate the safety and efficacy of lateral internal partial sphincterotomy for chronic anal fissure.
• To present the anatomy of the anal sphincters and the technique of subcutaneous partial sphincterotomy.
• To assess patient outcomes and complications following the procedure.

Main Methods:

• Prospective study of 43 patients undergoing lateral internal partial sphincterotomy between 2012 and 2013.
• Preoperative assessment of bowel habits and anal continence.
• Postoperative follow-up at 1 week, 1 month, and 6 months via office visits and telephone calls.
• Detailed presentation of anal canal anatomy using fresh specimen photographs.

Main Results:

• 93% of patients reported being pain-free within 1 week post-operation.
• Three patients (7%) required further sphincter division due to persistent pain.
• The most frequent complication was perianal burning (20.9%), followed by bleeding, itching, and temporary flatus incontinence.
• No cases of fecal incontinence were observed during the follow-up period.

Conclusions:

• Lateral internal partial sphincterotomy is a safe and effective technique for managing chronic anal fissure pain.
• The procedure is reproducible, with a high success rate and a low incidence of significant complications.
• Partial division of the internal sphincter appears sufficient for pain relief in the majority of patients.