Effective Surgical Treatment for Chronic Anal Fissures

Lateral Internal Sphincterotomy (LIS) is a highly effective surgical procedure for the treatment of chronic anal fissures that have not responded to conservative management. An anal fissure is a tear in the lining of the anal canal, often associated with spasm of the internal anal sphincter. LIS involves a controlled, partial division of the internal sphincter muscle to relieve spasm, improve blood flow, and promote healing.

Dr. Surendra Pal Jakhar specializes in LIS, utilizing advanced techniques to ensure precision, minimal discomfort, and excellent outcomes. This procedure is performed on an outpatient basis, allowing patients to return to their daily activities quickly.

What is an Anal Fissure?

• Definition: A tear or ulcer in the squamous epithelium of the anal canal, usually caused by trauma (hard stools, chronic constipation, or diarrhea).
• Acute vs. Chronic: Acute fissures heal within 6 weeks with conservative care; chronic fissures persist longer and may require surgical intervention.
• Pathophysiology: Anal sphincter spasm leads to reduced blood flow, impairing healing and perpetuating the cycle of pain and spasm.

Indications for LIS

• Chronic anal fissure lasting more than 6 weeks with no response to medical therapy
• Recurrent fissures after previous conservative treatment
• Fissures associated with significant pain and spasm
• Fissures with underlying sphincter hypertonia
• Fissures in patients with normal bowel habits

The LIS Procedure: Step-by-Step

• Anesthesia: Performed under local, regional, or general anesthesia for patient comfort.
• Positioning: The patient is placed in the lithotomy or prone position.
• Incision: A small incision (1-2 cm) is made in the perianal skin, laterally (to the side) to avoid the midline.
• Sphincter Division: The internal sphincter muscle is carefully identified and partially divided (usually about 30-50% of its thickness).
• Closure: The wound is left open or closed with absorbable sutures.
• Recovery: Patients are monitored in the recovery room and discharged the same day with postoperative instructions.

Benefits of Lateral Internal Sphincterotomy

• High Success Rate: Over 90% success rate in healing chronic anal fissures.
• Rapid Pain Relief: Significant reduction in pain, often within days after surgery.
• Outpatient Procedure: Performed as a day-care surgery, allowing same-day discharge.
• Minimal Scarring: Small incision with excellent cosmetic outcome.
• Quick Recovery: Most patients resume normal activities within 2-3 weeks.
• Preservation of Continence: Partial division of the sphincter minimizes the risk of incontinence.

Risks and Considerations

While LIS is safe and effective, it carries a small risk of complications, including:

• Mild incontinence (flatus or minor soiling) – usually temporary
• Infection or bleeding at the incision site
• Fissure recurrence (rare)
• Fecal impaction or constipation (managed with stool softeners and dietary changes)

Dr. Jakhar takes every precaution to minimize these risks and ensures comprehensive postoperative care.

Why Choose Dr. Surendra Pal Jakhar?

Dr. Surendra Pal Jakhar is a highly experienced colorectal surgeon with extensive expertise in performing Lateral Internal Sphincterotomy. His approach combines technical precision with personalized care plans. Dr. Jakhar works closely with a multidisciplinary team to provide holistic care for patients with perianal conditions, ensuring optimal outcomes and patient satisfaction.

Schedule a consultation today to discuss your anal fissure condition and explore whether LIS is the right option for you.