Newer method of segmental lateral internal sphincterotomy in chronic fissure-in-ano: a case report

Abstract

Fissure-in-ano is a common anorectal condition characterized by a linear tear distal to the dentate line, presenting with severe burning pain during defecation, constipation, and bleeding per rectum. Lateral internal sphincterotomy (LIS) remains the gold standard surgical intervention for chronic fissure-in-ano refractory to conservative management; however, it carries a well-recognized risk of postoperative anal incontinence, which has prompted investigation into technically modified approaches. Segmental lateral internal sphincterotomy (S-LIS), in which the internal anal sphincter is divided in two parts at different planes rather than as a single continuous cut, has been proposed as a continence-preserving alternative. In the present case report, a novel single-incision technique of segmental lateral internal sphincterotomy was employed, wherein both segments of the internal anal sphincter were sequentially elevated and divided through a single stab incision. The patient experienced an uneventful postoperative recovery, was discharged on postoperative day three, and demonstrated complete fissure healing with no recurrence on long-term follow-up. A systematic review of the literature identified four published studies, of which three clinical trials met eligibility criteria for inclusion. The single-incision segmental lateral internal sphincterotomy technique described herein may effectively eliminate the risk of postoperative anal incontinence while offering the additional advantages of a single wound, reduced procedural morbidity, and a minimally invasive operative approach.