Subcutaneous Lateral Internal Sphincterotomy

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS

Failure of medical therapies for anal fissure

CONTRAINDICATIONS
  • Inability to tolerate anesthesia
  • Bleeding diathesis
  • Severe perianal suppuration
EQUIPMENT
  • General surgical set
  • Anal retractor of choice
ANATOMY
  • Internal anal sphincter
  • External anal sphincter
  • Intersphincteric groove
  • Dentate line

PROCEDURE
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  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • A gauze anal wick is placed at the end of surgery.
  • Gauze is also packed in the open portion of the wound. Once the patient is home, he or she need only cover the wound with gauze.
  • Stool softeners and laxatives are important.
  • Sufficient pain medicine is crucial.
  • Sitz baths may be used.
COMPLICATIONS
  • Pain
  • Bleeding
  • Seepage of stool
  • Urinary retention
  • Abscess
  • Fistula formation
  • Incontinence (rare)
  • Fissure recurrence or nonhealing
RESULT ANALYSIS
  • Recurrence rates after closed or open SLIS are 0% to 30%.
  • Rates of incontinence are 5% early postoperatively to 3% 12 weeks postoperatively.
  • Rates of urinary retention were 17% in one large series.
  • Pain is the commonest postoperative complaint, with 96% of patients reporting some pain 6 weeks after surgery.
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