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Morbidity of internal sphincterotomy for anal fissure and stenosis
Abstract:
Internal sphincterotomy is thought by most surgeons to have minimal complications. We retrospectively reviewed 306 patients following internal sphincterotomy to determine the incidence of any complications. Major complications (requiring reoperation) caused by fistula, bleeding, abscess, or unhealed wounds occurred in ten patients (3 percent). Minor complications caused by pruritus, persistent wound, pain, bleeding, abscess, discharge, urgency, impaction, or defects of continence occurred in 110 patients (36 percent). Complications were lowest for closed sphincterotomy (20 percent) and highest for open sphincterotomy alone (55 percent). All patients were cured of anal fissure or stenosis. Long-term follow-up (average 4.3 years) revealed a 22 percent incidence of persistent minor complications. Defects in continence caused 15 percent of total long-term morbidity. Minor complications occur frequently after internal sphincterotomy for anal fissure and stenosis. Closed sphincterotomy has the lowest complication rate. Long-term minor defects in continence occur in a significant number of patients.
Insights
Internal sphincterotomy for anal fissure and stenosis has frequent minor complications, with closed sphincterotomy showing the lowest rates. Long-term follow-up reveals persistent minor issues, including significant continence defects.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes Research
Background:
- Internal sphincterotomy is a common surgical procedure for anal fissure and stenosis.
- It is generally perceived by surgeons to have a low complication rate.
Purpose of the Study:
- To retrospectively determine the incidence of major and minor complications following internal sphincterotomy.
- To compare complication rates between different sphincterotomy techniques.
Main Methods:
- Retrospective review of 306 patients who underwent internal sphincterotomy.
- Data collection on major complications (requiring reoperation) and minor complications.
- Analysis of complication rates based on surgical technique (closed vs. open sphincterotomy).
- Long-term follow-up (average 4.3 years) to assess persistent complications.
Main Results:
- Overall complication rate was 39% (10% major, 36% minor).
- Closed sphincterotomy had the lowest complication rate (20%), while open sphincterotomy alone had the highest (55%).
- Long-term follow-up showed a 22% incidence of persistent minor complications.
- Continence defects accounted for 15% of total long-term morbidity.
Conclusions:
- Minor complications are frequent after internal sphincterotomy for anal fissure and stenosis.
- Closed sphincterotomy is associated with a lower complication rate compared to open techniques.
- A significant number of patients experience long-term minor complications, particularly defects in continence.