How Much of the Internal Sphincter May Be Divided During Lateral Sphincterotomy for Chronic Anal Fissure in Women? Morphologic and Functional Evaluation After Sphincterotomy

Murad-Regadas, Sthela M.; Fernandes, Graziela Olívia da Silva; Regadas, Francisco Sérgio Pinheiro; Rodrigues, Lusmar Veras; Pereira, João R.; Filho, Francisco L. de Caldas; Dealcanfreitas, Iris Daiana; Holanda, Erico de Carvalho

doi:10.1097/dcr.0b013e31827a7416

Cited by 49 publications

(27 citation statements)

References 26 publications

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“…Division of less than 25% of the internal anal sphincter (IAS) was correlated with a minimal risk of incontinence. 51 The evaluation of patients with fecal incontinence should start with a thorough history and physical examination. Further studies including anorectal manometry, endorectal ultrasound, and pudendal nerve testing can assist in determining the cause of fecal incontinence.…”

Section: Fecal Incontinencementioning

confidence: 99%

Complications Following Anorectal Surgery

Kunitake

Poylin

2016

Clinics in Colon and Rectal Surgery

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Anorectal pathology is prevalent throughout the world, with most anorectal complaints being transient and without the need for formal medical evaluation. For those that do require surgical intervention for their anorectal pathology, the surgery can usually be done safely in the outpatient setting with minimal morbidity. However, no intervention is without risk, and complications frequently arise after anorectal surgery, with rates upward of 50% in some studies. 1 The purpose of this chapter is to review the short-and long-term complications that can arise after anorectal surgery, including the diagnostic approach, interventions, and prevention strategies for these complications. Short-Term/Acute Complications Postoperative HemorrhageMinor bleeding after anorectal surgery is common. Since we expect patients to continue with normal bowel function, the already disturbed anorectal mucosal becomes further irritated with activity and bowel movements. Since some bloody discharge is normal, the patient should be appropriately counseled on what to expect so as to avoid unnecessary anxiety and phone calls. It may also be helpful to remove/wash out clots from the rectum while still in the operating room to minimize confusion after surgery. However, major bleeding can also occur, albeit rarely, and may require further intervention. While the presentation of major bleeding is not uniform, patients often report frequent passing of small to moderate amounts of clot and bright red blood starting after the first bowel movement.Hemorrhoid surgery involves the vascular cushions of the anus, so not surprisingly, hemorrhoidectomy is associated with higher rates of bleeding when compared with other anorectal procedures. 1-3 Bleeding after other anorectal procedures such as procedures for anal fistula or fissure is very low (0.4-1.2%). 4,5 Rates of clinically significant bleeding after hemorrhoid surgery vary based on type of the procedure. For conventional hemorrhoidectomy (Milligan-Morgan and Ferguson) and bipolar energy device hemorrhoidectomy (Ligasure), rates of clinically significant hemorrhage has been reported in the range of 0.3 to 6%, with an average of around 2%. 1-3,6,7 There does not seem to be a significant difference in rates of bleeding between conventional hemorrhoidectomy and bipolar energy device assisted procedures.The timing of bleeding after hemorrhoidectomy varies, and can be generally divided into immediate and delayed. 5 Immediate bleeding occurs within 24 to 48 hours of a procedure and is likely related to loss of control of the vascular pedicle. Delayed bleeding is defined as bleeding reported up to 2 weeks postprocedure, and is more often related to infection or local trauma. 4,5 Delayed bleeding may be influenced by post-operative pain medications. Hemorrhoidectomy is associated with significant postoperative pain, and multimodality management is routinely employed to help alleviate discomfort. NSAIDS are an integral part of this pain management and can increase the incidence of bleeding. 8 Keywords ► anor...

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Section: Fecal Incontinencementioning

confidence: 99%

Complications Following Anorectal Surgery

Kunitake

Poylin

2016

Clinics in Colon and Rectal Surgery

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“…A recent review using three-dimensional anal ultrasonography to determine the extent of IAS division during LIS in women reported that the safest method is to divide less than 25% of the sphincter, which in women corresponds to less than 1 cm. No incontinence was observed in these patients [70]. It is important to ensure the sphincter is actually divided during LIS.…”

Section: Sphincterotomy Proceduresmentioning

confidence: 76%

Fissure-In-ANO

Fahadullah¹,

Peirce²

2018

Proctological Diseases in Surgical Practice

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This chapter provides a summary of the aetiology, diagnosis, investigation and management of anal fissure. It gives an overview of clinical anatomy and pathophysiology related to anal fissure. Focusing on anal sphincter hypertonia as the key factor for anal fissure progression, the chapter draws attention to perpetuating factors that contribute to a vicious cycle of fissure non-healing and addresses management options for these factors. This chapter also looks at the way how different treatment options for anal fissure emerged over time and uses evidence-based medicine to compare these options."Fissure-in-ANO" concludes with summarising the treatment options and suggesting an algorithm for management of acute and chronic anal fissures.

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“…Longer division of sphincter would lead to a higher rate of incontinence while shorter division may not relieve the spasm or heal the fissure. 11 Considering the cost of pre-operative evaluation, surgery cost and postoperative medications and stay in spinal group patients spent atleast three times more money than the local group patients for the same surgery. This carries greater significance in this setting where most of the patients come from poor economic backgrounds.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of local anaesthesia in lateral internal anal sphincterotomy for chronic anal fissure

Goudar¹,

Kalburgi²,

Lamani³

et al. 2018

Int Surg J

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Background: Fissure in Ano is one of the common and most painful anorectal conditions encountered in surgical practice. Inspite of several conservative treatment options, surgical treatment in the form of Lateral Anal Spincterotomy (LAS) remains the gold standard of treatment for Chronic Anal Fissures (CAF).Methods: Prospective comparative study conducted on 90 patients randomly divided into two groups Group A under Local anaesthesia (LA) and Group B under Spinal anaesthesia (SA) respectively. The primary outcome variables studied were postoperative pain, hospital stay, and cost effectiveness.Results: A total of 90 patients randomly divided into 45 patients in each group. There was no statistically difference in the pain at surgery, but post-operative pain was significantly less in LA group at 5th hour, 24 hours after surgery. Hospital stay in LA group is significantly less when compared to SA group (1.92, 3.75 respectively).Conclusions: LAS can be comfortably performed under LA with added advantages.

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How Much of the Internal Sphincter May Be Divided During Lateral Sphincterotomy for Chronic Anal Fissure in Women? Morphologic and Functional Evaluation After Sphincterotomy

Abstract: Based on data from this study, the safe extent of division is less than 25% of the total sphincter length, which in women corresponds to less than 1 cm.

Cited by 49 publications

References 26 publications

Complications Following Anorectal Surgery

Complications Following Anorectal Surgery

Fissure-In-ANO

Feasibility of local anaesthesia in lateral internal anal sphincterotomy for chronic anal fissure

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