FREQUENCY OF POSTOPERATIVE FECAL INCONTINENCE IN PATIENTS UNDERGOING OPEN ANAL INTERNAL SPHINCTEROTOMY FOR CHRONIC ANAL FISSURE
DOI:
https://doi.org/10.54112/pjicm.v5i02.147Keywords:
Fecal Incontinence, Anal Fissure, Internal SphincterotomyAbstract
Background: Chronic anal fissure is a common proctologic condition characterized by pain and bleeding during defecation. Open anal internal sphincterotomy is considered the gold standard surgical treatment, though postoperative fecal incontinence remains a concerning complication that can affect quality of life. Objective: To determine the frequency of postoperative fecal incontinence in patients undergoing open anal internal sphincterotomy for chronic anal fissure. Study Design: Descriptive study. Setting: The Department of General Surgery at Lady Reading Hospital, Peshawar, Pakistan. Duration of Study: 01-12-2024 to 01-05-2025. Methods: A total of 101 patients with chronic anal fissure were enrolled. Chronic fissure was defined as painful defecation with bleeding per rectum persisting for more than six weeks, with clinical findings of an anal mucosal tear or sentinel pile. All patients underwent open anal internal sphincterotomy under general anesthesia. Postoperative fecal incontinence was defined as uncontrolled passage of feces for ≥15 days after surgery. Data were analyzed using descriptive statistics. Results: The mean age of participants was 40.54 ± 14.85 years. There were 63 males (62.4%) and 38 females (37.6%). Postoperative fecal incontinence occurred in 15 patients, representing a frequency of 14.9%. Conclusion: Open anal internal sphincterotomy is an effective treatment for chronic anal fissure; however, postoperative fecal incontinence occurred in 14.9% of cases. Careful patient selection, preoperative counseling, and long-term follow-up are recommended to minimize and monitor this complication.
References
Salem AE, Mohamed EA, Elghadban HM, Abdelghani GM. Potential combination topical therapy of anal fissure: development, evaluation, and clinical study. Drug Deliv. 2018;25(1):1672-82. https://doi.org/10.1080/10717544.2018.1507059
Siddiqui J, Fowler GE, Zahid A, Brown K, Young CJ. Treatment of anal fissure: a survey of surgical practice in Australia and New Zealand. Colorectal Dis. 2019;21(2):226-33. https://doi.org/10.1111/codi.14466
Carter D, Dickman R. The role of Botox in colorectal disorders. Curr Treat Options Gastroenterol. 2018;16(4):541-7. https://doi.org/10.1007/s11938-018-0205-z
Bharucha AE, Knowles CH, Mack I, Malcolm A, Oblizajek N, Rao S, et al. Faecal incontinence in adults. Nat Rev Dis Primers. 2022;8(1):53. https://doi.org/10.1038/s41572-022-00381-7
Grossi U, De Simone V, Parello A, Litta F, Donisi L, Di Tanna GL, et al. Gatekeeper improves voluntary contractility in patients with fecal incontinence. Surg Innov. 2019;26(3):321-7. https://doi.org/10.1177/1553350618818924
Dexter E, Walshaw J, Wynn H, Dimashki S, Leo A, Lindsey I, et al. Faecal incontinence—a comprehensive review. Front Surg. 2024;11:1340720. https://doi.org/10.3389/fsurg.2024.1340720
Condon M, Mannion E, Molloy DW, O’Caoimh R. Urinary and faecal incontinence: point prevalence and predictors in a university hospital. Int J Environ Res Public Health. 2019;16(2):194. https://doi.org/10.3390/ijerph16020194
Thubert T, Cardaillac C, Fritel X, Winer N, Dochez V. [Definition, epidemiology and risk factors of obstetric anal sphincter injuries: CNGOF Perineal Prevention and Protection in Obstetrics Guidelines]. Gynecol Obstet Fertil Senol. 2018;46(12):913-21. https://doi.org/10.1016/j.gofs.2018.10.028
Vande Velde S, Van Renterghem K, Van Winkel M, De Bruyne R, Van Biervliet S. Constipation and fecal incontinence in children with cerebral palsy: overview of literature and flowchart for a stepwise approach. Acta Gastroenterol Belg. 2018;81(3):415-8.
Utzig MJ, Kroesen AJ, Buhr HJ. Concepts in pathogenesis and treatment of chronic anal fissure—a review of the literature. Am J Gastroenterol. 2003;98(5):968-74. https://doi.org/10.1111/j.1572-0241.2003.07423.x
Nyam DC, Pemberton JH. Long-term results of lateral internal sphincterotomy for chronic anal fissure with particular reference to incidence of fecal incontinence. Dis Colon Rectum. 1999;42(10):1306-10. https://doi.org/10.1007/BF02234220
Mentes BB, Tezcaner T, Yilmaz U, Leventoglu S, Oguz M. Results of lateral internal sphincterotomy for chronic anal fissure with particular reference to quality of life. Dis Colon Rectum. 2006;49(7):1045-51. https://doi.org/10.1007/s10350-006-0527-0
Ghayas N, Younus SM, Mirani AJ, Ghayasuddin M, Qazi A, Suchdev SD, et al. Frequency of post-operative faecal incontinence in patients with closed and open internal anal sphincterotomy. J Ayub Med Coll Abbottabad. 2015;27(4):878-82.
Chaudhary T, Chaudhari M, Kanzariya H, Nema A. A comparative study between open and closed lateral internal sphincterectomy in patients of chronic anal fissure. Int J Med Public Health. 2025;15(2):949-53. https://doi.org/10.70034/ijmedph.2025.2.171
Tanveer A, Arshad S, Fakih N, Farooq DA, Afyouni A, Kamran A, et al. Close lateral internal sphincterotomy versus open lateral internal sphincterotomy for chronic anal fissure: a systematic review and meta-analysis. Ann Med Surg (Lond). 2023;86(2):975-85. https://doi.org/10.1097/MS9.0000000000001593
Sabuncuoglu MZ, Sozen I, Zihni I, Celik G, Turan B, Acar S, et al. Comparative analysis of open and closed sphincterotomy for the treatment of chronic anal fissure: safety and efficacy evaluation. Med Sci Monit. 2024;30:e944127. https://doi.org/10.12659/MSM.944127
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