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Tailored lateral sphincterotomy for anal fissure
1Department of Surgery, Prince of Wales Hospital, University of New South Wales, Australia.
Diseases of the Colon and Rectum
|January 4, 1998
Summary
Tailored lateral sphincterotomy preserves more anal sphincter, significantly reducing incontinence rates compared to standard methods. This technique is safe and effective for treating anal fissures.
Area of Science:
- Colorectal Surgery
- Anal Fissure Treatment
- Sphincterotomy Techniques
Background:
- Standard lateral sphincterotomy involves division to the dentate line, often leading to incontinence.
- Chronic or acute anal fissures unresponsive to conservative treatment require surgical intervention.
Purpose of the Study:
- To evaluate the efficacy and safety of a "tailored" lateral sphincterotomy technique.
- To assess the impact of this modified approach on preserving anal sphincter function and reducing incontinence.
Main Methods:
- A retrospective review of 352 patients who underwent tailored left lateral sphincterotomy for anal fissures between 1976 and 1996.
- Analysis of patient outcomes, focusing on incontinence, staining, urgency, and recurrence rates.
Main Results:
- Of 287 reviewed patients (81.5% follow-up), only 1.4% reported flatus control issues, 0.35% minor staining, and 0.7% urgency.
- No cases of fecal incontinence or stool leakage were reported.
- Five patients required repeat sphincterotomies (4 for recurrence, 1 for persistent fissure).
Conclusions:
- Tailored lateral sphincterotomy is a safe and effective technique for anal fissure treatment.
- This method demonstrates a clinically significant reduction in incontinence rates.
- The tailored approach appears to preserve more anal sphincter function compared to standard techniques.