Lateral internal sphincterotomy is the current trend in treating anal fissures. Anal fissure is a small tear located around the anus, which makes bowel movements difficult. If not treated, this could lead to constipation and other complications related to digestion.
This surgery or any other surgery for that matter is only employed if the anal tear’s condition remains the same for 3-4 weeks despite changes in diet and usage of creams and pills. This is also recommended for those who have chronic anal fissures. It is considered the latter if the tear remains for 4-6 weeks.
Before the actual procedure, patients are recommended to take in two Fleet enemas, a saline laxative, the morning before the surgery to cleanse their colon from excrement. Fleet enemas soften the stools, making it easier to pass through the anus.
However, if the anal fissures are causing unbearable pain during bowel movement, the laxatives can be skipped. These are not administered to patients that have congestive heart failure and existing liver and kidney disease because its side effects can threaten the normal functions of these organs.
The surgeon would inject local or spinal anesthesia onto the patient to numb the pain. Then, the surgeon would cut the swelling internal anal sphincter, a muscle that is used by the anus for movement. Too much pressure on this muscle brings less blood flow bringing oxygen along the anus, preventing tissue repair and healing of the tear.
By cutting the internal anal sphincter, the tension around the anus is released. This gives the anal fissures enough room to rest and heal. The goal of sphincterotomy, therefore, is not to close the anal fissure but to give higher chances of healing the tear.
There are two kinds of lateral internal sphincterotomy available for patients: the open and closed surgery.
In a closed surgery, the cutting instrument is inserted into the intersphincteric groove or the passageway inside the anus that goes through the rectum. The instrument will be adjusted to reach the internal sphincter and cut it the same length as that of the anal fissure. The only wound that would be healed in this procedure is the anal fissure itself.
In an open surgery, an incision is made in the intersphincteric plane or the skin that transcends on top of the internal anal sphincter. The cutting instrument will be inserted through this incision and cut the sphincter through it. For this procedure, both the anal fissure and incision require healing.
After the surgery, some patients experience the uncontrollable passing of gas or stool, a condition called incontinence. This could be troublesome especially for patients who have to immediately go back to their normal lives after the procedure. Thus, before embarking on this surgery, it is essential to consult their respective healthcare providers so that they can weigh the pros and cons of the options available in treating anal fissures.
Luckily, the chances of getting incontinence after the surgery are only 8%. With such low statistical rate, patients opt for this procedure more than any other methods.
Please Share This Article - Thanks 🙂
