Lateral internal sphincterotomy for fissure-in-ano—Revisited

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Abstract
A disturbing complication rate following lateral internal sphincterotomy (LIS) has recently been reported, and this study assessed our complication rate. Charts of 312 patients who were operated on between January 1975 and December 1993 were reviewed. There were 148 men (47.5 percent) and 164 women (52.5 percent), ranging in age from 16 to 95 (mean, 40) years. Two hundred sixty-five patients underwent LIS as a primary and sole procedure. Mean follow-up time was 20.4 months (range, 2 weeks-215 months). Healing times were less than one month (11.6 percent), one month (73.2 percent), one to two months (9.6 percent), and more than two months, 5.6 percent. Twenty-three complications (8.7 percent) occurred in 20 (7.5 percent) of the 265 patients: delayed healing (> 60 days) of the sphincterotomy site (13); persistence or recurrence of the fissure (3); wound infection (2); incontinence to flatus (1); soiling (1); temporary incontinence to flatus and stool (1); prolapsed hemorrhoids (1); fecal impaction (1). Most complications were minor and resolved spontaneously. Reoperations included one revision and one hemorrhoidectomy. This review supports the belief that LIS is a good operation for patients with chronic anal fissure and can successfully be performed under local anesthetic as an outpatient procedure with an acceptable complication rate.