Long–term assessment of fecal incontinence after lateral internal sphincterotomy

Rotholtz, Nicolás A.; Bun, Maximiliano; Mauri, M. V.; Bosio, Raul M.; Peczan, Carlos; Mezzadri, Norberto A

doi:10.1007/s10151-005-0208-3

Cited by 45 publications

(27 citation statements)

References 29 publications

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“…A major complication of internal sphincterotomy is fecal incontinence in anywhere from 5 to 31 percent of patients. [7][8][9][10][11][12] The fecal incontinence does not always recover, even after long-term follow-up. In one study of 68 patients undergoing internal sphincterotomy, fissures healed in 97 percent of patients, whereas 10.3 percent were incontinent and did not improve with time.…”

Section: Discussionmentioning

confidence: 91%

“…In one study of 68 patients undergoing internal sphincterotomy, fissures healed in 97 percent of patients, whereas 10.3 percent were incontinent and did not improve with time. 8 Nonetheless, lateral internal sphincterotomy is currently the standard of care for surgical treatment of fissures and is regarded as a safe and effective treatment, which only occasionally impairs continence. 1 Before the widespread acceptance of left-lateral internal sphincterotomy, several Bhistoric^proce-dures focused on obliterating all three components of the fissure: the fissure itself, the sentinel tag, and the hypertrophied papilla.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] Additionally, persistence of fissures is reported in up to 10 percent of patients after internal sphincterotomy. [6][7][8][9] The constant presence of a subcutaneous tract extending caudad from chronic fissures and extending into sentinel tags (when present) was identified by the senior author (DNA). These tracts were surgically explored by using a narrow-gauge lacrimal probe and were found to extend caudally for 1 cm or more in the subcutaneous plane.…”

Section: Purposementioning

confidence: 99%

See 2 more Smart Citations

Subcutaneous Fissurotomy: A Novel Procedure for Chronic Fissure-in-ano. A Review of 109 Cases

Pelta¹,

Davis²,

Armstrong³

2007

Diseases of the Colon &Amp; Rectum

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Purposementioning

confidence: 99%

See 1 more Smart Citation

Subcutaneous Fissurotomy: A Novel Procedure for Chronic Fissure-in-ano. A Review of 109 Cases

Pelta¹,

Davis²,

Armstrong³

2007

Diseases of the Colon &Amp; Rectum

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“…One group have shown that rates of continence impairment decreased from 45% within a week of surgery to 11.5% a month after the procedure [74]. However, in a second study with a low overall early incidence of incontinence (10.3%), these rates did not change with time [76]. A more recent study reported that rates of incontinence following LIS are similar to those in patients undergoing topical therapy [77].…”

Section: Sphincterotomymentioning

confidence: 88%

A review of chronic anal fissure management

Collins

Lund

2007

Tech Coloproctol

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Anal fissure management has rapidly progressed in the last 15 years as our understanding of fissure pathophysiology has developed. All methods of treatment aim to reduce the anal sphincter spasm associated with chronic anal fissures. Surgical techniques have been used for over 100 years with success. Lateral internal sphincterotomy remains the surgical treatment of choice for many practitioners. Postoperative impairment of continence remains controversial. Recently, less invasive methods of treatment have been explored. Topical nitrates, calcium channel blockers and botulinum toxin are established treatments. These and other non-surgical treatments are described in this review. Various guidelines and treatment algorithms for anal fissure are also discussed.

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“…Disadvantages of internal sphincterotomy include; disturbance of continence, bleeding, fistula, abscess, persistent wound pain, cost and time of recovery [3]. These have led to search for another mode of therapy or pharmacologic way to create a temporary or reversible sphincterotomy, one that would lower the sphincter pressure only until the fissure healed [4].…”

Section: Introductionmentioning

confidence: 97%

Lokales Nitroglyzerin vs. Sphinkterotomie bei chronischer Analfissur

2010

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Zusammenfassung. Grundlagen: Es galt, die Wirkung von lokalem Nitroglyzerin versus Sphinkterotomie beim Management der chronischen Analfissur zu vergleichen.Methodik: 80 Personen mit chronischer Analfissur wurden mit GTN 0,2 % (n ¼ 40) oder mit interner Sphinkterotomie (n ¼ 40) behandelt und die Wirksamkeit der Methoden verglichen.Ergebnisse: In der GTN-Gruppe war in 85 % der Fälle nach 8 Wochen Therapie eine Abheilung der Fissur zu beobachten. Kopfschmerz als Nebenwirkung bestand bei 65 % der Fälle. In der Sphinkterotomie-Gruppe trat Beschwerdefreiheit bei 97,5 % der Personen nach 8 Wochen ein. Inkontinenz für Gas bestand bei 3 Patienten (7,5 %), Stuhlschmieren bei 2 Personen (5 %) und 1 Patient hatte eine Wundinfektion. Alle Komplikationen waren transient, außer Persistenz für Gas-Inkontinenz bei einem Patienten.Schlussfolgerungen: Lokales GTN sollte die initiale Therapie bei chronischer Analfissur sein, während die Sphinkterotomie bei Personen angewendet werden, die nicht auf GTN ansprechen oder starke Beschwerden haben.Schlüsselwörter: Analfissur, Nitroglyzerin, Sphinkterotomie.Summary. Background: To compare the effectiveness of local glyceryl trinitrate (GTN) versus internal sphincterotomy in the management of chronic anal fissure.Methods: Eighty patients with chronic anal fissure were enrolled in the study. They were divided into two groups; group (1) included 40 patients treated with topical GTN 0.2% on liposomal base applied to the anoderm twice daily and group (2) included 40 patients treated with internal sphincterotomy. We compared the effectiveness of both techniques in the management of chronic anal fissure.Results: In group 1, healing of fissures occurred in 85% of patients after 8 weeks therapy. Headache as a side effect developed in 65% of patients. In group 2, healing occurred in 97.5% of patients after 8 weeks. Incontinence to flatus occurred in 3 patients (7.5%), mild soiling in 2 patients (5%), and one patient developed wound infection. All complications were temporary except for one patient with persistent incontinence to flatus. At the end of 8 weeks both groups were equal in pain scoring.Conclusions: Topical GTN should be the initial treatment in chronic anal fissure while internal sphincterotomy may be reserved for patients who did not respond to GTN therapy and those with severe pain (as healing is faster with sphincterotomy).

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Long–term assessment of fecal incontinence after lateral internal sphincterotomy

Abstract: Incontinence due to LIS does not recover after long-term follow-up and appears to be an independent cause of fecal incontinence.

Cited by 45 publications

References 29 publications

Subcutaneous Fissurotomy: A Novel Procedure for Chronic Fissure-in-ano. A Review of 109 Cases

Subcutaneous Fissurotomy: A Novel Procedure for Chronic Fissure-in-ano. A Review of 109 Cases

A review of chronic anal fissure management

Lokales Nitroglyzerin vs. Sphinkterotomie bei chronischer Analfissur

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