Dilip's Transmucosal Internal Sphincterotomy: A Simplified Approach to Lateral Internal Sphincterotomy for Fissure in...

Area of Science:

• Colorectal surgery
• Surgical innovation
• Anorectal diseases

Background:

• Anal fissures are common and painful, often requiring lateral internal sphincterotomy.
• Traditional methods carry risks, especially for less experienced surgeons or in specific patient populations.
• A safer, more accessible surgical approach is needed.

Purpose of the Study:

• To introduce and evaluate Dilip's transmucosal internal sphincterotomy as a simplified alternative.
• To assess the safety, efficacy, and patient outcomes of this novel technique.
• To compare transmucosal internal sphincterotomy with traditional methods.

Main Methods:

• The transmucosal internal sphincterotomy procedure involves minimal mucosal incision under saddle block anesthesia.
• Retractors and stay sutures enhance visibility and control of the internal sphincter.
• No closure is required, reducing postoperative pain and complications.

Main Results:

• 124 patients underwent transmucosal internal sphincterotomy between December 2020 and February 2022.
• Median operative time was 7 minutes with low postoperative pain.
• Low rates of infection (2.5%), transient incontinence (3%), and recurrence (1.6%) were observed, with most patients healing within 9 weeks.

Conclusions:

• Transmucosal internal sphincterotomy demonstrates significant advantages over traditional methods.
• Benefits include reduced pain, fewer complications (hematoma, abscess, fistula), and no painful nodules.
• The technique is recommended for surgical education due to its reproducibility and improved patient outcomes, particularly for junior surgeons.