(Sphincterectomy, Anal; Surgery for Anal Fissures; Lateral Internal Sphincterotomy; LIS)
DefinitionThis is a procedure to treat chronic anal fissures. An anal fissure is a painful tear in the lining of the anus. The anus is the opening through which stool passes from the body. Tears generally occur just inside the opening.
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Reasons for ProcedureMuscle spasms in the rectum can prevent fissures from healing. A sphincterotomy relieves these muscle spasms. Anal fissures often heal by taking certain steps, such as:
- Eating a high-fiber diet
- Drinking plenty of fluids
- Using stool softeners
- Taking warm baths
- Using medications applied to the skin
Possible ComplicationsProblems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Inability to control the leakage of gas or stool from the rectum
- Adverse reaction to anesthesia
- Anal abscess or fistula formation
What to Expect
Prior to ProcedureBefore surgery, your doctor may do the following determine the extent of your fissure:
- Physical exam and health history
- Digital rectal exam—The doctor inserts a lubricated finger into the anus and feels for lumps or abnormalities.
- Anoscopy—A tool is inserted in the anus to allow the doctor to examine the anal canal.
- Ask you to take steps to clean out your bowels.
- The day before the surgery:
- Eat a light breakfast and lunch.
- Drink clear liquids only after lunch. Clear liquids include items such as water, broth, juices without pulp, popsicles, and clear Jell-O. Talk to your doctor about which liquids are allowed.
- Do not eat or drink after midnight the night before surgery:
- You may also be asked to give yourself an enema to help clean out your bowel.
- The day before the surgery:
AnesthesiaDepending on which option is best for you, your doctor may give you:
- Local anesthesia that will only numb the rectal area
- General anesthesia—You will be asleep during the surgery.
Description of ProcedureIf there are any skin tags near the fissure, they will be removed. Next, the doctor will carefully make a cut on the anal sphincter muscle. This will relax the sphincter and allow it to stretch, taking pressure off the fissure. The doctor will put a dressing into your anus to stop the bleeding.
How Long Will It Take?Less than one hour
How Much Will It Hurt?Anesthesetics will prevent pain during the procedure. Pain and discomfort after the procedure can be managed with medications.
Post-procedure CareAt the Care CenterYou may be given pain medications and instructions for how to care for your rectal area. A nurse may change your dressing or instruct you on how to change it.Preventing InfectionDuring your stay, the care center staff will take steps to reduce your chance of infection, such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
- Washing your hands often and reminding your healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch your incision
- Keeping the rectal area clean
- Using a sitz bath to ease discomfort and cleaning
- Avoiding sexual activity and heavy lifting until your doctor says it is okay
- Over-the-counter or prescription pain relievers
- Stool softeners and dietary changes to prevent constipation