Table of ContentsView AllTable of ContentsPurposeRisksHow to PrepareThe ProcedureRecoverySummary
Table of ContentsView All
View All
Table of Contents
Purpose
Risks
How to Prepare
The Procedure
Recovery
Summary
Sphincterotomy, also called a lateral internal sphincterotomy, is a type of procedure that is used to cut the anal sphincter. Theanal sphincteris the group of muscles connected to the rectum, at the end of the digestive tract, through which bowel movements are passed.
This surgery is done when ananal fissure(a break in the skin of the anus) hasn’t gotten better after trying other treatments. Fissures can bleed and be painful, and in some cases, they may take time to heal.
Sphincterotomy is considered the gold standard for treating chronic anal fissures, and the success rate is usually reported as being about or greater than 95%, according to some research.
Having a fissure come back again (recur) after a sphincterotomy is rare, and most patients are satisfied with the results of the procedure.
This article discusses the reasons for a sphincterotomy, how the surgery is performed, and the potential risks of the procedure.
Shannon Fagan / Getty Images
Why Would You Need a Sphincterotomy?
When at-home treatments—including eating more fiber, drinking more water, using stool softeners, and takingsitz baths—are not effective in healing chronic anal fissures, a sphincterotomy may be considered. (Botoxinjections are another treatment that may be tried before surgery.)
Anal fissure surgery can cost anywhere between $4,000 and $9,000 depending on several factors including the severity of your condition, your insurance, as well as where you live.
Risks and Contraindications
In the majority of cases, a sphincterotomy is successful and patients are satisfied. However, as with any type of surgery, there are certain risks, as well as the potential for complications. Some of the complications that can occur with sphincterotomy include:
Certain medical conditions, such as hypothyroidism,obesity, and chronic constipation, are aassociated with an increased risk of developing an anal fissure.
A sphincterotomy is a type of minor surgery, so the surgeon will give instructions as to what should be done to prepare. For general anesthetic, it may be necessary to stop eating or drinking at midnight the night before the procedure.
For local anesthetic, the instructions may be the same or, in some cases, eating and drinking might be allowed up to a certain point prior to the surgery.
Blood thinnersor other medications that thin the blood might need to be stopped for several days before surgery.
You will not be able to drive themselves home after this procedure, so you’ll need a friend or family member to take you home.
At check-in, you’ll have your medical history taken. The healthcare provider will as questions about any current medications or supplements, any allergies, and any past reactions to anesthesia or other medications. You’ll need to sign release forms before you can be prepped for the procedure.
An IV will be placed for fluids and any medications (such asanesthesiaor sedatives) that are needed. When it is time to begin the procedure, you will be wheeled into the operating room.
A lateral internal sphincterotomy may be performed as “open” or “closed.” The type of procedure that is done will depend on a number of factors.
In open surgery, an anoscope is inserted into the anal sphincter to see the muscles and the fissure. The incision is made in the inner anal sphincter muscle.
In most cases, a sphincterotomy is done as an outpatient procedure. It may be done under local or general anesthetic. In some cases, the incision may be left open to heal; in others, it may be closed up. Most people will be able to go home the same day as the procedure.
After the surgery, a dressing might be placed inside the anus. When the surgery is complete, patients are monitored for a few hours to ensure that everything has gone well. After that period in recovery is over, patients will either be discharged to go home or, if a hospital stay is needed, they will be taken to a hospital room.
Prognosis After SurgeryThe success rate for healing after having a sphincterotomy is around 92% in individuals who aren’t at risk for developing complications.
Prognosis After Surgery
The success rate for healing after having a sphincterotomy is around 92% in individuals who aren’t at risk for developing complications.
Sphincterotomy Recovery at Home
Most people will need at least a day to recover from general anesthesia and find they need to stay home from work and regular activities for about a week (or in some cases, about two weeks).
You may be sent home with a prescription for pain relievers or other medications and the instructions on how to take them. In some cases, patients report that the pain experienced after the procedure is less painful than the anal fissure itself.
Other home care instructions may include how to use a sitz bath several times a day, how much water to drink, and how to eat a high-fiber diet to help stools become softer and easier to pass. In some cases,stool softenersmay also be prescribed.
You may experience pain after sphincterotomy surgery. In the first few days, the most pain may occur during a bowel movement. It is important to keep stools soft and to avoid straining.
There may be some bleeding for a week or more after the surgery, but it should be seen mostly on the paper after wiping.
It usually takes around six to 10 weeks to fully recover from sphincterotomy surgery.
Recovery is usually uneventful, but any excessive pain or bleeding should be reported to a healthcare provider immediately. Most people feel better and have less pain in a few days; however, it may take about six weeks for the incision to heal completely.
Having incontinence that persists after the first few days is not common,but if it continues, it should be discussed with a healthcare provider. If the fissure returns (a rare occurrence), it may need further treatment.
As with any surgery, there are risks and potential complications, but in general, people recover from a sphincterotomy in around six to 10 without problems.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Henning W, Deppen JG.Internal anal sphincterotomy. In: StatPearls.Radwan MM, Ramdan K, Abu-Azab I, Abu-Zidan FM.Botulinum toxin treatment for anal fissure.Afr Health Sci. 2007;7(1):14–17. doi:10.5555/afhs.2007.7.1.14Beaty JS, Shashidharan M.Anal fissure.Clin Colon Rectal Surg. 2016;29(1):30–37. doi:10.1055/s-0035-1570390Prabhakaran M, Narayanasami B, Rekha A.Assessment of thyroid profile in patients with fissure in ano in the South Indian population.Int Surgery Journal. Vol. 6 No. 10 (2019): October 2019. doi: 10.18203/2349-2902.isj20194426Davies I, Dafydd L, Davies L, Beynon J.Long term outcomes after lateral anal sphincterotomy for anal fissure: a retrospective cohort study.Surg Today. 2014;44(6):1032-1039. doi:10.1007/s00595-013-0785-0American Society of Colon and Rectum Surgeons.Anal fissure.Acar T, Acar N, Güngör F, et al.Treatment of chronic anal fissure: Is open lateral internal sphincterotomy (LIS) a safe and adequate option?.Asian J Surg. 2019;42(5):628-633. doi:10.1016/j.asjsur.2018.10.001Additional ReadingNessar G, Topbas M.Lateral Internal Partial Sphincterotomy Technique for Chronic Anal Fissure.Indian J Surg.2016;79:185-187. DOI: 10.1007/s12262-016-1467-0.Salih AM.Chronic anal fissures: Open lateral internal sphincterotomy result; a case series study.Ann Med Surg (Lond).2017;15:56-58. DOI: 10.1016/j.amsu.2017.02.005
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Henning W, Deppen JG.Internal anal sphincterotomy. In: StatPearls.Radwan MM, Ramdan K, Abu-Azab I, Abu-Zidan FM.Botulinum toxin treatment for anal fissure.Afr Health Sci. 2007;7(1):14–17. doi:10.5555/afhs.2007.7.1.14Beaty JS, Shashidharan M.Anal fissure.Clin Colon Rectal Surg. 2016;29(1):30–37. doi:10.1055/s-0035-1570390Prabhakaran M, Narayanasami B, Rekha A.Assessment of thyroid profile in patients with fissure in ano in the South Indian population.Int Surgery Journal. Vol. 6 No. 10 (2019): October 2019. doi: 10.18203/2349-2902.isj20194426Davies I, Dafydd L, Davies L, Beynon J.Long term outcomes after lateral anal sphincterotomy for anal fissure: a retrospective cohort study.Surg Today. 2014;44(6):1032-1039. doi:10.1007/s00595-013-0785-0American Society of Colon and Rectum Surgeons.Anal fissure.Acar T, Acar N, Güngör F, et al.Treatment of chronic anal fissure: Is open lateral internal sphincterotomy (LIS) a safe and adequate option?.Asian J Surg. 2019;42(5):628-633. doi:10.1016/j.asjsur.2018.10.001Additional ReadingNessar G, Topbas M.Lateral Internal Partial Sphincterotomy Technique for Chronic Anal Fissure.Indian J Surg.2016;79:185-187. DOI: 10.1007/s12262-016-1467-0.Salih AM.Chronic anal fissures: Open lateral internal sphincterotomy result; a case series study.Ann Med Surg (Lond).2017;15:56-58. DOI: 10.1016/j.amsu.2017.02.005
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Henning W, Deppen JG.Internal anal sphincterotomy. In: StatPearls.Radwan MM, Ramdan K, Abu-Azab I, Abu-Zidan FM.Botulinum toxin treatment for anal fissure.Afr Health Sci. 2007;7(1):14–17. doi:10.5555/afhs.2007.7.1.14Beaty JS, Shashidharan M.Anal fissure.Clin Colon Rectal Surg. 2016;29(1):30–37. doi:10.1055/s-0035-1570390Prabhakaran M, Narayanasami B, Rekha A.Assessment of thyroid profile in patients with fissure in ano in the South Indian population.Int Surgery Journal. Vol. 6 No. 10 (2019): October 2019. doi: 10.18203/2349-2902.isj20194426Davies I, Dafydd L, Davies L, Beynon J.Long term outcomes after lateral anal sphincterotomy for anal fissure: a retrospective cohort study.Surg Today. 2014;44(6):1032-1039. doi:10.1007/s00595-013-0785-0American Society of Colon and Rectum Surgeons.Anal fissure.Acar T, Acar N, Güngör F, et al.Treatment of chronic anal fissure: Is open lateral internal sphincterotomy (LIS) a safe and adequate option?.Asian J Surg. 2019;42(5):628-633. doi:10.1016/j.asjsur.2018.10.001
Henning W, Deppen JG.Internal anal sphincterotomy. In: StatPearls.
Radwan MM, Ramdan K, Abu-Azab I, Abu-Zidan FM.Botulinum toxin treatment for anal fissure.Afr Health Sci. 2007;7(1):14–17. doi:10.5555/afhs.2007.7.1.14
Beaty JS, Shashidharan M.Anal fissure.Clin Colon Rectal Surg. 2016;29(1):30–37. doi:10.1055/s-0035-1570390
Prabhakaran M, Narayanasami B, Rekha A.Assessment of thyroid profile in patients with fissure in ano in the South Indian population.Int Surgery Journal. Vol. 6 No. 10 (2019): October 2019. doi: 10.18203/2349-2902.isj20194426
Davies I, Dafydd L, Davies L, Beynon J.Long term outcomes after lateral anal sphincterotomy for anal fissure: a retrospective cohort study.Surg Today. 2014;44(6):1032-1039. doi:10.1007/s00595-013-0785-0
American Society of Colon and Rectum Surgeons.Anal fissure.
Acar T, Acar N, Güngör F, et al.Treatment of chronic anal fissure: Is open lateral internal sphincterotomy (LIS) a safe and adequate option?.Asian J Surg. 2019;42(5):628-633. doi:10.1016/j.asjsur.2018.10.001
Nessar G, Topbas M.Lateral Internal Partial Sphincterotomy Technique for Chronic Anal Fissure.Indian J Surg.2016;79:185-187. DOI: 10.1007/s12262-016-1467-0.Salih AM.Chronic anal fissures: Open lateral internal sphincterotomy result; a case series study.Ann Med Surg (Lond).2017;15:56-58. DOI: 10.1016/j.amsu.2017.02.005
Nessar G, Topbas M.Lateral Internal Partial Sphincterotomy Technique for Chronic Anal Fissure.Indian J Surg.2016;79:185-187. DOI: 10.1007/s12262-016-1467-0.
Salih AM.Chronic anal fissures: Open lateral internal sphincterotomy result; a case series study.Ann Med Surg (Lond).2017;15:56-58. DOI: 10.1016/j.amsu.2017.02.005
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