REAPPRAISAL OF PARTIAL LATERAL INTERNAL SPHINCTEROTOMY

PURPOSE: The aim of this study was to delineate the results, mortality , and morbidity of partial lateral internal sphincterotomy for the tre atment of chronic anal fissure. METHOD: A retrospective review of 500 patients undergoing partial lateral internal sphincterotomy for chroni c anal fissure between 1980 and 1390 was performed. Patients were iden tified by a review of an office surgical ledger and included ah patien ts whose diagnosis was anal fissure and for whom a partial lateral int ernal sphincterotomy was performed as treatment. RESULTS: Over an aver age follow-up of 5.6 years, only 1 percent of patients failed to heal their fissures after performance of this operation. Minor complication s included pain, pruritus, wound abscess, discharge, delayed healing, bleeding, fecal impaction, minor incontinence, and urgency and were pr esent in IG percent of patients, postoperatively. Two percent of patie nts who initially healed their fissures suffered a recurrence. Complic ation rates in open vs. closed sphincterotomy were 15 percent vs. 8 pe rcent (P < 0.01). Disorders of fecal continence occurred in 8 percent of patients over the long term. CONCLUSION: Extended follow-up after p artial lateral internal sphincterotomy demonstrates a higher complicat ion rate than was seen in patients being followed for shorter periods. However, the complication of impaired fecal continence only occurred in 8 percent of our patients, compared with 15 percent reported in the current literature, although using the same evaluative criteria. Pati ent satisfaction with the results of surgery was 98 percent. Careful p atient selection, absence of preoperative continence problems, and met iculous surgical techniques are necessary to achieve this type of resu lt.