Symposium on outpatient anorectal procedures. Lateral internal sphincterotomy: rationale, technique and anesthesia.

To determine the role of lateral internal sphincterotomy under local anesthesia in patients with anal fissures, a retrospective review of 133 patients (62 men, 71 women) was conducted. They ranged in age from 19 to 79 years. The open technique described by Sir Alan Parks was adopted, except that the operation was performed under local anesthesia as an outpatient procedure. Associated operations were performed in nine patients (6.5%). Complications, which occurred in seven patients (5.3%), included difficulty controlling flatus, incomplete wound healing and thrombosed external and prolapsing internal hemorrhoids. Relief of pain was prompt. The advantages of this operation are that hospitalization is not necessary, it can be performed under local anesthesia, postoperative discomfort is of short duration and wounds heal quickly. This report supports the use of lateral internal sphincterotomy for patients with a chronic anal fissure.