Neil Hyman1. 1. Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont 05401, USA. neil.hyman@vtmednet.org
Abstract
PURPOSE: Lateral internal sphincterotomy is an effective treatment for chronic anal fissures; however, the risk of "incontinence" has generated interest in pharmacologic approaches that are far less effective and may be poorly tolerated. This study was designed to objectively define the risk of incontinence with sphincterotomy using the Fecal Incontinence Severity Index and assess the implications for quality of life using the Fecal Incontinence Quality of Life Scale. METHODS: A prospective study was undertaken on all patients undergoing lateral internal sphincterotomy for a chronic anal fissure by a single surgeon at a university teaching hospital from January 1, 2000 to September 30, 2002. All patients had failed at least six weeks of nonoperative management. Patient demographics and use of nitroglycerin were noted. The Fecal Incontinence Severity Index was measured preoperatively and at a six-week postoperative visit when fissure healing and postoperative complications were assessed. The Fecal Incontinence Quality of Life Scale was administered to patients with an incontinence score>0. RESULTS: Thirty-five patients (15 males) underwent sphincterotomy during the study period. Thirty-one of 35 had failed nitrates: 10 because of unacceptable side effects, and 21 because of lack of efficacy. Thirty-two patients returned for their six-week postoperative visits, and two completed their questionnaires by telephone. One patient was lost to follow-up. Mean age was 41.2 (range, 21-67) years. Thirty of 32 (94 percent) evaluable fissures had healed by six weeks, one healed by three months, and the other required V-Y anoplasty. There were two minor complications. Three patients had postoperative deterioration in their continence score. Quality of life deteriorated in only one patient. CONCLUSIONS: Lateral internal sphincterotomy is a safe and effective treatment for chronic anal fissures that only occasionally impairs continence and rarely diminishes quality of life.
PURPOSE: Lateral internal sphincterotomy is an effective treatment for chronic anal fissures; however, the risk of "incontinence" has generated interest in pharmacologic approaches that are far less effective and may be poorly tolerated. This study was designed to objectively define the risk of incontinence with sphincterotomy using the Fecal Incontinence Severity Index and assess the implications for quality of life using the Fecal Incontinence Quality of Life Scale. METHODS: A prospective study was undertaken on all patients undergoing lateral internal sphincterotomy for a chronic anal fissure by a single surgeon at a university teaching hospital from January 1, 2000 to September 30, 2002. All patients had failed at least six weeks of nonoperative management. Patient demographics and use of nitroglycerin were noted. The Fecal Incontinence Severity Index was measured preoperatively and at a six-week postoperative visit when fissure healing and postoperative complications were assessed. The Fecal Incontinence Quality of Life Scale was administered to patients with an incontinence score>0. RESULTS: Thirty-five patients (15 males) underwent sphincterotomy during the study period. Thirty-one of 35 had failed nitrates: 10 because of unacceptable side effects, and 21 because of lack of efficacy. Thirty-two patients returned for their six-week postoperative visits, and two completed their questionnaires by telephone. One patient was lost to follow-up. Mean age was 41.2 (range, 21-67) years. Thirty of 32 (94 percent) evaluable fissures had healed by six weeks, one healed by three months, and the other required V-Y anoplasty. There were two minor complications. Three patients had postoperative deterioration in their continence score. Quality of life deteriorated in only one patient. CONCLUSIONS: Lateral internal sphincterotomy is a safe and effective treatment for chronic anal fissures that only occasionally impairs continence and rarely diminishes quality of life.