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

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.