Abstract
Objective
Subcutaneous lateral internal sphincterotomy (SLIS) is an effective treatment for fissure in ano but carries a definite risk of incontinence. The aim of this study was to assess the efficacy and complications of SLIS in patients with chronic fissure in ano.
Materials and methods
All patients presenting with a chronic anal fissure who underwent SLIS were entered into a prospective database. This is a review of these patients over 5 year’s period (September 2002–2007). All operations were performed or directly supervised by a consultant colorectal surgeon. Short-term follow-up was at the first outpatient appointment (6 weeks postoperatively) and any impairment of continence was documented.
Results
During the study period of 5 years, 96 patients underwent SLIS at our institution. Median patient age was 45 years (range 19–81). The median duration of symptoms was 65 days. No fissure failed to heal after SLIS. Minor complications were noted in five patients; 85% (82/96) attended the follow-up and out of these, 6% (5/82) reported early incontinence. One patient was incontinent to flatus, one to liquid and three to solid stool. After 12 weeks of follow-up, two patients were completely symptom free, one was incontinent to flatus and two were incontinent to liquid stool.
Conclusion
SLIS remains an effective treatment for chronic anal fissure. A small proportion of patients do suffer from faecal incontinence, which may be permanent in some cases. Careful patient selection and proper surgical training can reduce this risk.
Similar content being viewed by others
References
Utzig MJ, Kroesen AJ, Buhr HJ (2003) Concepts in pathogenesis and treatment of chronic anal fissure: a review of the literature. Am J Gastroenterol 98:968–974
Schouten WR, Briel JW, Auwerda JA et al (1996) Ischemic nature of anal fissure. Br J Surg. 83:63–65
Gibbons CP, Read NW (1986) Anal hypertonia in fissures: cause or effect? Br J Surg. 73:443–445
Lock MR, Thompson JS (1977) Fissure in ano: the initial management and prognosis. Br J Surg. 64:355–358
Lund JN, Scholefield JH (1996) Aetiology and treatment of anal fissure. Br J Surg. 83:1335–1344
McCallion K, Gardiner KR (2001) Progress in understanding treatment of chronic anal fissure. Postgrad Med J. 77:753–758
Brodie BC (1835) Lectures on the diseases of the rectum; Lecture III; preternatural contraction of the sphincter ani. London Medical Gazette. 16:26–31
Eisenhammer S (1959) The evaluation of the internal anal sphincterotomy operation with special reference to anal fissure. Surg Gynecol Obstet. 109:583
Notaras MJ (1969) Lateral subcutaneous internal anal sphincterotomy for anal fissure—a new technique. J R Soc Med. 62:713
Bailey RV, Rubin RJ, Salvati EP (1978) Lateral internal sphincterotomy. Dis Colon Rectum. 21:584–586
Argov S, Levandovsky O (2000) Open lateral sphincterotomy is still the best treatment for chronic anal fissure. Am J Surg. 197:201–202
Hananel N, Gordon PH (1997) Lateral internal sphincterotomy for fissure in ano revisited. Dis Colon Rectum. 40:597–602
Nelson RL (1999) Meta-analyses of operative techniques for fissure in ano. Dis Colon Rectum. 42:1424–1428
Magee H, Thompson H (1966) internal anal sphincterotomy as an outpatient procedure. Gut. 7:190–192
Walker WA, Rothenberger DA, Goldberg SM (1985) Morbidity of internal sphincterotomy for anal fissure and stenosis. Dis Colon Rectum. 28:832–835
Garcia-Aguilar J, Belmonte Montes C, Wong D et al (1996) Open vs closed sphincterotomy for chronic anal fissure. Dis Colon Rectum. 39:440–443
Nyam DC, Pemberton JH (1999) Long term results of lateral internal sphincterotomy for chronic anal fissure with particular reference to incidence of faecal incontinence. Dis Colon Rectum. 42:1306–1310
Hsu TC, Mackeigan JM (1984) Surgical treatment of chronic anal fissure: a retrospective study of 1753 cases. Dis Colon Rectum. 27:475–478
Khubchandni IT, Reed JF (1989) Sequale of internal sphincterotomy for chronic fissure in ano. Br J Surg. 76:431–434
Sultan AH, Kamm MA, Nicholls RJ, Bartram CI (1994) Prospective study of the extent of internal anal sphincter division during lateral sphincterotomy. Dis Colon Rectum. 37:1031–1033
Felt-Bersma RJ, van Barren R, Korevaar M, Strijers RL, Cuesta MA (1995) Unsuspected sphincter defects shown by anal endosonography after anorectal surgery: a prospective study. Dis Colon Rectum. 38:249–253
Richard CS, Gregoire R, Plewes EA et al (2000) Internal sphincterotomy is superior to nitro glycerine in the treatment of chronic anal fissure: results of a randomised controlled trial by the Canadian Colorectal Surgical Trials Group. Dis Colon Rectum. 43:1048–1058
Melange M, Colin JF, Van Wymersch T, Vanheuverzwyn R (1992) Anal fissure: correlation between symptoms and manometry before and after surgery. Int J Colorectal Dis. 7:108–111
Tocchi A, Mazzoni G, Miccini M, Cassini D, Betelli E, Brozzetti S (2004) Total lateral sphincterotomy for anal fissure. Int J Colorectal Dis. 19:245–249
Usatoff V, Polglase AL (2008) The longer term results of internal sphincterotomy for anal fissure. Aust N Z J Surg 65:576–579
Littlejohn DR, Newstead GL (1997) Tailored lateral sphincterotomy for anal fissure. Dis Colon Rectum. 40:1139–1142
Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal sphincter disruption during vaginal delivery. N Eng J Med. 329:1905–1911
Lund JN, Armitage NC, Scholefield JH (1996) Use of glyceryl trinitrate in the treatment of anal fissure. Br J Surg. 83:776–777
The Royal College of Surgeons of England in association with the Association of Coloproctology of Great Britain and Ireland. Analyses of 1997 study on anal fissure in children and adult. April 1998
Brown SR, Taylor A, Adam IJ et al (2002) The management of persistent and recurrent chronic anal fissure. Colorectal Disease. 4:226–232
Nelson RL (2002) Outcome of operative procedures for fissure in ano. Cochrane Database Syst Rev 1:CD002199
Altomare DF, Rinaldi M, Milito G et al (2000) Glyceryl trinitrate for chronic anal fissure—healing or headaches? Results of a multi-centre randomised placebo controlled double blinded trial. Dis Colon Rectum. 43:174–181
Nelson R, Norton N, Cautley E, Furner S (1995) Community-based prevalence of anal incontinence. JAMA 274:559–561
Hunskaar S, Burgio K, Clark A et al (2005) Epidemiology of urinary and fecal incontinence and pelvic organ prolapse. In: Abrams P, Cardozo S, Khourey S, Wein A (eds) Incontinence: 3rd International Consultation on Incontinence. International Continence Society, Bristol
Shaw C (2001) A review of psychosocial predictors of help seeking behaviour and impact on quality of life in people with urinary incontinence. J Clin Nurs 10(1):15–24
Brown CJ, Dubreuil D, Santoro L et al (2007) Lateral internal sphincterotomy is superior to topical nitro-glycerine for healing chronic anal fissure and does not compromise long-term fecal continence: six-year follow-up of a multicenter, randomized, controlled trial. Dis Colon Rectum 50:442–448
Mentes BB, Tezcaner T, Yilmaz U et al (2006) Results of lateral internal sphincterotomy for chronic anal fissure with particular reference to quality of life. Dis Colon Rectum 49:1045–1051
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Khan, J.S., Tan, N., Nikkhah, D. et al. Subcutaneous lateral internal sphincterotomy (SLIS)—a safe technique for treatment of chronic anal fissure. Int J Colorectal Dis 24, 1207–1211 (2009). https://doi.org/10.1007/s00384-009-0765-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-009-0765-4