Lateral Internal Sphincterotomy

Abstract

Indication • Chronic anal fissure Essential Steps 1. Rectal exam. 2. Inject local anesthetic. 3. Anoscopy. 4. Identify the fissure and curet the base. 5. Identify the intersphincteric groove and make an incision. 6. Elevate and divide fibers of the internal sphincter. 7. Achieve hemostasis. 8. Close the wound. Note These Variations • Prone jackknife vs. lithotomy position vs. left lateral decubitus • Longitudinal incision into the anal canal (open technique) on occasion used Complications • Bleeding/hematoma formation • Incontinence • Recurrence • Urinary retention Template Operative Dictation Preoperative Diagnosis Chronic anal fissure Procedure Lateral internal sphincterotomy Postoperative Diagnosis Same Indications This ___-year-old male/female had anal fissure of duration refractory to medical management. Lateral internal sphincterotomy was elected for management. Description of Procedure The patient was brought to the operating room. Time-outs were performed using both preinduction and pre-incision safety checklists to verify correct patient, procedure, site, and additional critical information prior to beginning the procedure. General/ spinal/monitored care anesthesia was induced. The patient was placed in the prone jackknife/ lithotomy/left lateral decubitus position. The perineum was prepped and draped in the usual sterile fashion. Local anesthetic was injected as a