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Non-standardized surgery lateral internal sphincterotomy: Is there a consensus?

Neriman Şengül1, Buse Balcı1, Hatice Maras2

  • 1Department of General Surgery, Bolu Abant İzzet Baysal University Faculty of Medicine, Bolu, Türkiye.

Turkish Journal of Surgery
|July 7, 2025
PubMed
Summary

Surgical techniques for lateral internal sphincterotomy (LIS) lack standardization globally. Practice variations are more influenced by surgeon location than individual characteristics, highlighting a need for consensus in treating chronic anal fissures.

Keywords:
Chronic anal fissureinternational surveylateral internal sphincterotomy

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Area of Science:

  • Colorectal surgery
  • Surgical technique standardization
  • Gastrointestinal health

Background:

  • Lateral internal sphincterotomy (LIS) is the standard surgical treatment for chronic anal fissures.
  • Significant variability exists in the surgical techniques employed for LIS.
  • Lack of established consensus on optimal LIS procedures.

Purpose of the Study:

  • To investigate practice variations among surgeons performing LIS.
  • To determine if a consensus exists for lateral internal sphincterotomy techniques.
  • To identify factors influencing LIS procedural choices.

Main Methods:

  • Anonymous online survey distributed to surgeons worldwide.
  • 24-question survey assessing technical approaches to LIS.
  • Data collected from 207 international surgeons.

Main Results:

  • Widespread heterogeneity in LIS techniques observed, including open vs. closed methods and sphincterotomy extent.
  • Significant variations noted in pre-operative preparation, patient positioning, and management of anal conditions.
  • Geographic location, rather than surgeon demographics, was a stronger predictor of technique preference.
  • Routine use of anorectal manometry was low (6%).

Conclusions:

  • A standardized approach to lateral internal sphincterotomy is currently lacking among international surgeons.
  • Surgical technique preferences for LIS demonstrate significant variation.
  • Geographic practice location appears to be a more influential factor than surgeon characteristics in LIS technique selection.