What is lateral internal sphincterotomy?

Lateral internal sphincterotomy is surgery to help heal an anal fissure that has not improved with medicine or other treatments. An anal fissure is a tear in the lining of the anus.

During the surgery, the doctor puts a lighted tube (called an anoscope, or scope) into the anus. The doctor is able to see the inside of the anus through the scope. Special surgical tools are guided through the scope into the anus. The doctor uses the surgical tools to make a cut (incision) in the internal anal sphincter. The internal anal sphincter is a ring of muscle that controls the anus. This surgery relieves the pressure and allows the anal fissure to heal.

This surgery may be done while you are completely asleep or while you are awake. If you are awake, you will be given medicine to help you relax. You will not feel pain. The surgery usually takes less than 30 minutes. Most people go home the same day.

Many people notice that the pain from their anal fissure goes away within several days after surgery. But it will probably take about 6 weeks for your anus to completely heal. You will probably be able to go back to work and your usual activities about 1 to 2 weeks after surgery.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

What happens before surgery?

Having surgery can be stressful. This information will help you understand what you can expect and how to safely prepare for surgery.

Preparing for surgery

• Bring a list of questions to ask your doctors. It is important that you understand exactly what surgery is planned, the risks, benefits, and other options before your surgery.
• Tell your doctors ALL the medicines and natural health products you take. Some of these can increase the risk of bleeding or interact with anesthesia. Your doctor will tell you which medicines to take or stop before your surgery.
• If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if you should stop taking these medicines before your surgery. Make sure that you understand exactly what your doctor wants you to do.
• You may need to stop taking certain medicines a week or more before surgery, so talk to your doctor as soon as you can.
• Before your surgery, you will speak with an anesthesia provider to discuss your anesthetic options, including the risks, benefits, and alternatives to each. This may be on the phone or in person.

Taking care of yourself before surgery

• Build healthy habits into your life. Changes are best made several weeks before surgery, since your body may react to sudden changes in your habits.
  • Stay as active as you can.
  • Eat a healthy diet.
  • Cut back or quit alcohol and tobacco.
• If you have an advance care plan, let your doctor know. If you do not have one, you may want to prepare one so your doctor and loved ones know your health care wishes. Doctors recommend that everyone prepare these papers before surgery, regardless of the type of surgery or condition.

What happens on the day of surgery?

• Follow the instructions exactly about when to stop eating and drinking, or your surgery may be cancelled. If your doctor has instructed you to take your medicines on the day of surgery, please do so using only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Remove all jewellery, piercings, and contact lenses.
• Leave your valuables at home.

The day before surgery

• You may need to empty your colon with an enema or laxative. Your doctor will tell you how to do this.

At the hospital or surgery centre

• Bring a picture ID.
• Before surgery you will be asked to repeat your full name, what surgery you are having, and what part of your body is being operated on. The area for surgery may be marked.
• A small tube (IV) will be placed in a vein, to give you fluids and medicine to help you relax. Because of the combination of medicines given to keep you comfortable, you may not remember much about the operating room.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may range from making you fully asleep, to simply numbing the area being worked on. This will depend on the procedure you are having, as well as a discussion between your doctor, the anesthesia provider, and you.
• The surgery will take about 30 minutes.
• As you wake up in the recovery room, the nurse will check to be sure you are stable and comfortable. It is important for you to tell your doctor and nurse how you feel and ask questions about any concerns you may have.

Going home

• Be sure you have someone to drive you home.
• For your safety, you should not drive until you are no longer taking pain medicines and you can move and react easily.
• Arrange for extra help at home after surgery, especially if you live alone or provide care for another person.
• You will be given more specific instructions about recovering from your surgery, including activity and when you may return to work.

When should you call your doctor?

• You have questions or concerns.
• You don't understand how to prepare for your surgery.
• You become ill before the surgery (such as fever, flu, or a cold).
• You need to reschedule or have changed your mind about having the surgery.