Non-standardized surgery lateral internal sphincterotomy: Is there a consensus?

Objective: Lateral internal sphincterotomy (LIS) is considered the gold standard surgical treatment for chronic anal fissures. However, substantial variation exists in the surgical techniques applied. This study aims to evaluate practice differences among surgeons performing LIS and to assess whether a consensus has been established.

Material and methods: An anonymous online survey was conducted to assess surgeons' technical approaches to LIS. Data were collected using a 24-question survey targeting surgeons from various countries.

Results: A total of 207 surgeons (131 from Türkiye, 76 from other countries) responded. The majority were male (73.3%) and between 40 and 64 years of age (64.7%). Most participants (70%) had more than 10 years of surgical experience, and 55% were affiliated with academic centers. The open technique was preferred by 73.6% of respondents, while 21.4% opted for the closed method. Partial sphincterotomy was favored by 66%, followed by complete (21%) and tailored (12%) approaches. Substantial heterogeneity was noted in bowel preparation, patient positioning, incision type, and management of skin tags or hypertrophied papillae. Only 6% reported routine use of anorectal manometry. Variations were more prominent across countries than between demographic groups. The principal finding of the study is the lack of a standardized approach to LIS across international surgical communities.

Conclusion: There is no standardized approach to LIS among surgeons. Surgical technique preferences vary significantly and appear to be influenced more by geographic practice location than by individual surgeon characteristics such as age, gender, or experience.