Mid-thickness vertical sphincterotomy: A solution for postoperative anal incontinence?

Introduction

Anal fissure is the most common cause of anorectal pain worldwide. Treatment is based on both medical and surgical methods. Surgical management by internal lateral sphincterotomy is the standard treatment, with well-defined indications. There is a high incidence of anal incontinence following this surgery. In order to reduce the occurrence of this complication, we are conducting a study to evaluate a sphincter-sparing surgical technique for the treatment of anal fissures.

Methodology

We conducted a descriptive cross-sectional study with prospective data collection from January to December 2022 on patients with isolated anal fissure at Yaoundé Central Hospital. Patients fulfilling the inclusion criteria were operated on using the vertical internal midline sphincterotomy technique performed by the same surgical team. Anal incontinence was assessed using the Jorge-Wexner score. Results were analyzed using IBM SPSS 20 software.

Results

15 patients fulfilling the inclusion criteria were operated on; the mean age of this population was 33 years. 60% of fissures were acute. The most frequent indication for surgery was failure and/or unavailability of medical treatment. The average operating time was 30 min. There was very little bleeding or pain, and we recorded one case of postoperative soiling with a Joge and Wexner score of 1 which subsided after one week. No other complications were noted. Healing of the fissure took place between 16 and 30 days post-op.

Conclusion

Preliminary results of mid-thickness vertical sphincterotomy show advantages such as very low morbidity, rapid healing, absence of complications. No major episodes of incontinence were observed in the series using the Joge &Wexner scale.