Impact of lateral internal sphincterotomy on quality of life and postoperative faecal incontinence in chronic anal fissure: An observational before and after study.

AIM: To evaluate the impact of lateral internal sphincterotomy on symptom resolution and quality of life, overall and related to faecal incontinence, in patients with chronic anal fissure.

METHODS

An analytical observational before- and after study was conducted in adults with chronic anal fissure who underwent lateral internal sphincterotomy between 2020 and 2024. Quality of life changes were assessed using the EQ-5D-5L and VAS Score. In patients with preoperative faecal incontinence, changes were evaluated using the Faecal Incontinence Quality of Life Scale (FIQLS). FIQLS and VAS scores were compared using the Wilcoxon signed-rank test, and EQ-5D-5L changes were analysed using the Paretian Classification of Health Change,Probability of Superiority and Health Profile Matrix.

RESULTS

A total of 332 patients were analysed, 52.1% male (173/332), with a median age of 43 years (IQR 34-55). According to the Paretian Classification of Health Change, 85.6% (279/326) showed an overall improvement in quality of life. All EQ-5D-5L domains demonstrated improvement after the procedure, with the greatest impact observed in the pain/discomfort domain (96.9%, 281/290). These findings were supported by probability of superiority values (mobility = 0.53; self-care = 0.54; usual activities = 0.64; pain/discomfort = 0.92; anxiety/depression = 0.58) and were reflected in the Health Profile Matrix. Preoperative faecal incontinence was present in 7.8% (26/332), with no significant changes in quality of life according to FIQLS.

CONCLUSION

Lateral internal sphincterotomy improved overall quality of life in patients with chronic anal fissure without worsening faecal incontinence related quality of life and was associated with symptom resolution.