Find Out About Lateral Internal Sphincterotomy (LIS) Surgery

Overview

Not many things are as uncomfortable and painful as anal fissures. An anal fissure is a tear in the lining of the anus, the opening through which stool is removed from your body. These fissures are usually caused by trauma to the anus and anal canal due to factors such as chronic constipation, prolonged diarrhea, straining during bowel movement, or anal infections.

Anal fissures can result in symptoms such as pain, bleeding, and visible cracks in the anus or anal canal. Conservative measures such as preventing constipation, soaking in a warm water bath, and applying medicated creams or ointments may help in treating anal fissures. 

However, in some cases, the fissures do not heal or may get worse, and surgery becomes the only viable option for treating them. Let’s find out more about anal fissure surgery called lateral internal sphincterotomy (LIS).

What Is Lateral Internal Sphincterotomy (LIS)?

Lateral internal sphincterotomy (LIS) is a surgery for the treatment of anal fissures. This surgery is called “lateral internal sphincterotomy” because it involves cutting a small portion of the internal anal sphincter muscle laterally or from the side. 

There are 2 muscles in the anal sphincter. The external muscle is under voluntary control while the internal muscle is under the control of the nervous system. These muscles work together to control bowel movement out of the body. 

During lateral internal sphincterotomy (LIS), a muscle in the internal anal sphincter is cut or stretched. This helps reduce pressure inside the anus, eases the associated pain and discomfort, and increases blood flow to the area to help the tissue heal.

When Is Lateral Internal Sphincterotomy (LIS) Recommended?

There are several ways to treat an anal fissure. These methods include:

• Preventing constipation with dietary and lifestyle changes
• Soaking in a sitz bath (a warm, shallow water bath to sit in) to relax the anal muscles
• Keeping the anorectal area cleaned and lubricated
• Avoiding straining on the toilet
• Using hydrocortisone-containing suppositories, foams, or creams
• Applying medicated creams, muscle relaxants, anesthetic ointments, etc
• Injecting Botox into the anal sphincter muscle

A lateral internal sphincterotomy is recommended when none of these home remedies or conservative treatment modalities are successful in treating a chronic (long-term) anal fissure. 

How To Prepare For Lateral Internal Sphincterotomy (LIS)?

• Your surgeon will schedule a pre-surgery consultation, where you can discuss the procedure in detail, your expectations from the surgery, and its benefits and risks. Do not hesitate to clarify all your doubts about the procedure during this consultation. 
• The surgeon will also discuss your medical and surgical history before the procedure. 
• Tell the surgeon about any medications and supplements you are currently taking, allergies, and any past reactions to anesthesia you may have had. You may be asked to discontinue medication such as blood thinners that may increase the risk of bleeding during surgery. 
• Depending on the type of anesthesia to be administered, you may be asked to stop eating or drinking anything for a few hours before the procedure. 
• You will have to arrange for someone to drive you home after the procedure.

How Is Lateral Internal Sphincterotomy (LIS) Performed?

• You are moved into the operating room and an IV (intravenous) is placed for fluids, anesthesia, or sedatives needed during the procedure. 
• Lateral internal sphincterotomy can be performed under general anesthesia or local anesthesia. If you are given local anesthesia and are awake during the surgery, the surgeon may give you a sedative to help you relax.
• Lateral internal sphincterotomy can be performed as either open surgery or closed surgery. 
• In open lateral internal sphincterotomy (LIS), the surgeon inserts an anoscope (a lighted tube) into the anal sphincter to see the muscles and the fissure. Then, they make a small incision in the skin near the anus to access the inner anal sphincter muscle and cut it laterally with small medical tools. An open LIS may require stitches to close the incision.
• In closed lateral internal sphincterotomy (LIS), a small incision is made inside the anal canal, between the inner and the outer anal sphincter muscle. The scalpel is inserted through this incision and the internal anal sphincter muscle is cut laterally. This approach does not require an external incision and hence no stitches are needed. 

What To Expect After Lateral Internal Sphincterotomy (LIS)?

• After the surgery, a dressing may be placed inside the anus. 
• You will be monitored for a few hours. Lateral internal sphincterotomy (LIS) is generally regarded as a day-care procedure and most individuals should be able to go home on the same day.
• Once you are home, take adequate rest for the day. You may need to stay off work and other activities for 1 to 2 weeks. 
• Expect some amount of pain for the first-week post-surgery. However, the pain starts resolving in a few days. 
• There may also be some bleeding for a few days post-surgery. You may notice this as small amounts of blood on your toilet paper after a bowel movement. 
• The surgeon will provide you with a prescription for medications such as pain relievers. They may also prescribe a mild laxative or stool softener to ease bowel movements. 
• It may take about 6 weeks for your anus to heal completely.
• During the recovery period: 
  • Take short walks every day to prevent constipation and increase blood flow.
  • Drink lots of fluids and eat fiber-rich food to prevent pain when you pass a bowel movement. 
  • Keep your feet on a small stool when you sit on the toilet to get into a squatting position.
  • Take several short-duration sitz baths in a day to promote healing.
  • Use baby wipes or medicated wipes to clean the anal area instead of toilet paper. 
  • Shower or bathe as normal. However, avoid using fragranced soaps and pat the anal area dry afterward.

What Are The Benefits & Risks of Lateral Internal Sphincterotomy (LIS)?

Benefits:

There are several benefits associated with lateral internal sphincterotomy (LIS), including:

• High success rate in the treatment of anal fissures
• Quick recovery from the procedure
• Reduced pain during bowel movements
• Low complication rates
• Lesser chances of return of anal fissures
• Improved quality of life

Risks:

The risks or complications associated with lateral internal sphincterotomy (LIS) include:

• Infection
• Bleeding
• Anal incontinence
• Difficulty controlling flatulence
• Persistent pain
• Formation of scar tissue at the incision site

Why Choose Medfin?

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!