Lateral Internal Sphincterotomy Steps, Procedure, Recovery, Complications

The treatment option for anal fissures other than medications or dietary changes is characterized as Lateral Internal Sphincterotomy. It helps in treating the fissures by lowering the pressure in the anus. It assists in the reduction of anus spasms by increasing blood flow, and this, in turn, aids in tissue healing. 

Anal fissures are caused by anal muscle spasms and can cause significant anal pain, which usually takes place at the time of bowel movement. Typically, anal fissures are treated with warm baths and medicines. If the medicines fail to treat the disease, then this surgical treatment of lateral internal sphincterotomy is preferred by medical professionals. Local anesthetic or sedation is used during lateral internal sphincterotomy. 

The surgeon begins by carefully checking the anal canal using a small, stiff anoscope. Once the anal fissure is found, the procedure can proceed using one of two surgical techniques which are as follows: 

1. Open lateral internal sphincterotomy.
2. Closed lateral internal sphincterotomy.

Lateral Internal Sphincterotomy Steps

The doctors follow the following steps during the surgery:

1. The doctor inserts a lighted tube (anoscope, or scope) into the anus during surgery. 
2. The scope allows the physician to see the interior of the anus. The doctor checks the anus from the inside to proceed further.
3. Specialized surgical instruments are guided into the anus through the scope.
4. The doctor makes an incision in the internal anal sphincter with surgical tools.
5. This surgery is completed within less than 30 minutes. 
6. This operation removes the pressure on the anal fissure and allows it to recover. 

Lateral Internal Sphincterotomy Procedure

The procedure of lateral internal sphincterotomy is quite simple and mostly preferred by physicians. The patient is given spinal or general anesthesia at the start of the procedure. The purpose of this surgery is to treat the fissure by cutting the hypertrophied internal sphincter. This tiny incision is made to expose the muscle of the internal sphincter. By visibility of this muscle, the doctors can proceed to the next step. In the next step, the muscle is divided with the help of the thermal cautery by the surgeon. As a result, the pressure is relieved and the healing of the anal fissures takes place.

The other type of this surgery characterized as closed lateral internal sphincterotomy is also similar to the open lateral internal sphincterotomy. Instead of cutting the skin, in this approach, the surgeon observes the gap between the external and internal sphincter and locates it. The muscle in this case is divided by putting a scalpel into the gap and gently moving it toward the internal sphincter. This procedure takes about 30 minutes on average.

Lateral Internal Sphincterotomy Recovery

The following points help in the recovery of the disease:

1. Regular exercise assists the patient in quickly returning to normal activities. 
2. The patient must consult his/her healthcare provider or primary physician.
3. Most people heal completely and can resume normal activities. The fissure’s pain also subsides quickly. 
4. The anus typically recovers in six weeks, it normally takes one to two weeks to completely recover from the disease or resume the normal activities including going to work.
5. It is important to consult the doctors for follow-up because the fissure can reappear, and the patient requires additional therapy. 
6. As usual, take a shower or bath, but dry the anal region afterward.
7. Drink a lot of water.
8. Consume a diet high in fiber.
9. Sit in 10 centimeters of warm water three times per day, following bowel movements, till the time the pain in the anus is reduced.
10. While moving the bowels, the little steps are preferred for supporting the feet. This helps in stretching the hips and squatting position of the pelvis, which makes it easier to release a stool.
11. Soaps with added fragrances should be avoided.

Lateral Internal Sphincterotomy Complications

This surgery sometimes leads to certain kinds of complications which may include; modest fecal incontinence and difficulties in managing flatulence. This adverse effect normally goes away on its own when your anus heals, although it can be persistent in certain circumstances. 

The patient experiences bleeding throughout the procedure, which will normally require sutures. Thus, there is a possibility of perianal abscess development. This is usually developed with an anal fissure.