Lateral Internal Sphincterotomy

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Lateral Internal Sphincterotomy

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What is Lateral Internal sphincterotomy?

Lateral internal sphincterotomy is a surgery for treating an anal fissure, i.e., a tear in the anus opening causing pain, itching, and bleeding. It aids in relieving pain arising due to spasms by reducing pressure inside the anus and increasing blood supply to the surrounding area enabling the tissue to heal.

An anal fissure is a common disease that affects both children and adults and is caused by forcefully passing a large, firm, or hard bowel.However, repeating cycles of such forced bowel movements can cause severe pain and bleeding, , that don't easily heal, leading to chronic anal fissures.

Benefits of Lateral Internal Sphincterotomy (LIS)

A lateral internal sphincterotomy is a surgery that repairs an anal fissure.

  1. It helps reduce pressure inside the anus that can cause spasms and increases blood flow to the area to help the tissue heal.
  2. It helps heal an anal fissure that has not improved with medicine or other treatments

Who needs this procedure?

Reasons for Considering Surgery

 

Complications of anal fissure can include:

 

A tear stretching to surrounding muscles – An anal fissure may tear into a muscle ring that holds the anus closed (internal anal sphincter), thus preventing the anal fissure from healing easily

 

Failure to heal – Chronic anal fissure fails to heal within eight weeks and require further medical intervention.

 

Pain or discomfort – Unhealed fissures cause despair, demanding medications or surgery to relieve the pain and cure the fissure.

 

  1. Recurrence – After experiencing an anal fissure once, individuals may experience another one.
  2. Trouble passing stool – Constant pain makes   bowel movement more difficult.
  3. Constant bleeding – After wiping stool, people likely find bright red streaks of blood on toilet paper.
  4. Clotting – Due to the frequent bleeding patient may find blood clots in the surrounding areas of the anal fissure.
  5. Inability to control gas or bowel movements – People suffering from this may experience sudden or frequent gas or bowel movements.
  6. Reduced quality of life – People often feel embarrassed due to constipation, constant pain & bleeding or frequent gas or bowel movements. This embarrassment further increases stress and affects   socio-psychological behaviour.

Lateral Internal Sphincterotomy (LIS)

Sphincterotomy Procedure

  1. At first, the surgeon carefully inspects the anal canal using an anoscope to identify the anal fissure.
  2. At this point, the surgeon can go with any one of the two surgical methods: open or closed lateral internal sphincterotomy.
  3. In the open technique, the internal sphincter muscle fibres are exposed by making a small incision on either side of the anal skin. The surgeon then lifts the internal anal sphincter muscle through a hemostat or similar tool, separating it sharply with a knife or thermal cautery. This process relaxes the pressure in the anus and enables the fissure to heal.
  4. Unlike the open technique, the closed method begins by locating a groove between the internal and external sphincter muscles through touching them. After identifying, a scalpel is inserted down to this grove towards the internal sphincter to cut and separate the muscle.
  5. In both approaches, the incision aims to release the tension of the sphincter as the high pressure inside the anus prevents anal fissures from healing.

What to expect before the procedure?

  1. The patient's positioning is based on the preference of the surgeon.
  2. The patient must change their garments and prepare in sterile clothing.
  3. Lateral internal sphincterotomy can be performed in the office using a local anaesthetic or performed under regional or general anaesthetic in the operating room.
  4. While performing Lateral internal sphincterotomy in the office, a local anaesthetic is used however performing in an operating room requires regional or general anaesthetic.
  5. The type of anaesthesia used is decided according to patient and surgeon preference.
  6. A lateral internal sphincterotomy usually takes 30 minutes to complete, and generally, the patients are discharged on the same day.
  7. Patients can either be asleep or awake during surgery and if the patient is awake, the surgeon gives medicine to relax the patient. 
  8. The surgeon inserts a scope, or lighted tube, into the anus during the procedure to better understand the injury. 
  9. Small incision tools are used to cut the internal anal sphincter, the small muscle ring responsible for controlling the anus.

 

 

Recovery and Pot op care after Lateral Internal Sphincterotomy (LIS)

After Surgery

The pain mainly lasts for a few days and goes away within a week, thus allowing patients to resume their regular activities; however, it takes six weeks to recover completely.

Following are some suggestions for post-procedure care:

  1. Get a lot of rest.
  2. Take daily short walks to avoid constipation and enhance blood flow.
  3. To avoid pain when using the bathroom, always keep hydrated and consume a fiber   enriched diet.
  4. Use a little stool beneath your feet to put your body in a squatting position in the toilet.
  5. To promote healing, take numerous short sitz baths throughout the day.
  6. Use baby wipes or medicated wipes instead of toilet paper to clean the area.

Risk and complication of Procedure

The most common complication after surgery is anal incontinence. Around half of patients experience this after surgery, but for most, it resolves over time. This can show up as the loss of stool or the inability to control your gas. Other minor complications include: 

  1. Infection
  2. Excessive bleeding
  3. Fistula 

Expert Doctors for Lateral Internal Sphincterotomy

Dr. Atul N.C. Peters

Dr. Atul N.C. Peters

Laparoscopic / Minimal Access Surgery, Bariatric Surgery / Metabolic, General Surgery
26 years experience
98% Recommended
Dr. Atul Wadhwa

Dr. Atul Wadhwa

General Surgery
27 years experience
98% Recommended
Dr. Yogesh Gautam

Dr. Yogesh Gautam

General Surgery, Laparoscopic / Minimal Access Surgery
43 years experience
96% Recommended
Dr. S K Tiwari

Dr. S K Tiwari

General Surgery
40 years experience
99% Recommended
Dr. V K Jain

Dr. V K Jain

General Surgery
45 years experience
98% Recommended
Dr. Sandeep Kumar Jain

Dr. Sandeep Kumar Jain

General Surgery
19 years experience
99% Recommended
Dr. P K Dewan

Dr. P K Dewan

Laparoscopic / Minimal Access Surgery, Bariatric Surgery / Metabolic, Metabolic And Bariatric Surgery
40 years experience
97% Recommended
Dr. Vivek Bindal

Dr. Vivek Bindal

Laparoscopic / Minimal Access Surgery, Bariatric Surgery / Metabolic, Department of General Surgery and Robotics, Metabolic And Bariatric Surgery
24 years experience
98% Recommended

NABH Accredited Hospitals for Lateral Internal Sphincterotomy

Alpine Hospital

Alpine Hospital

Plot No. 140, Near Mother Dairy 122001
Excellence in General Surgery
4.9/5
Apex Hospital, Naraina Vihar

Apex Hospital, Naraina Vihar

E-22, Goswami Girdhari Lal Marg 110028
Excellence in General Surgery
4.8/5
Max Super Speciality Hospital, Shalimar Bagh

Max Super Speciality Hospital, Shalimar Bagh

FC 50, Max Wali Rd, C And D Block 110088
Excellence in General Surgery
4.8/5
Avantika Multispeciality Hospital

Avantika Multispeciality Hospital

A3/8, 110085
Excellence in General Surgery
4.9/5
BH Salvas Hospital

BH Salvas Hospital

Chandan Palace 110043
Excellence in General Surgery
4.8/5
CDAS Super Speciality Hospital

CDAS Super Speciality Hospital

Malibu Town 122018
Excellence in General Surgery
4.5/5
Cloudnine Hospital, Patparganj

Cloudnine Hospital, Patparganj

Community Centre, Plot, Street Number 6B 110092
Excellence in General Surgery
4.5/5
Diyos Hospital

Diyos Hospital

A1/26 110029
Excellence in General Surgery
4.8/5

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