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Complications of LIS Surgery

Lateral internal sphincterotomy (LIS) is a common surgical procedure used to treat anal fissures. During the procedure a small incision is made in the sphincter in order to disrupt the painful spasms caused by anal fissures and to allow greater blood flow to the area. Although complications are rare, they can happen. Before undergoing LIS it is important to learn about potential complications – discuss these with a doctor to decide if LIS is right for you.

  1. Failed Surgery

    • Sometimes LIS doesn’t work the first time. However, LIS failure rates are currently reported as less than 5 percent according to Dr. Michael Mulholland and Dr. Gerard Doherty in their book “Complications in Surgery.” Usually in these cases LIS is prescribed again, and the operation will occur on the other side of the sphincter. Before the second LIS surgery, doctors will perform an ultrasound and other tests to check the patient's condition. If incontinence is an issue the patient may be given a Botox injection prior to the surgery to reduce symptoms.

    Incontinence

    • The inability to control flatulence or the passage of stool occurs in some LIS patients. Although these symptoms usually disappear after a short time on their own, about one percent to two percent of patients find that fecal incontinence does persist, according to Drs. Mulholland and Doherty. Patients that fail to heal properly after LIS surgery are checked for the presence of other conditions such as Crohn’s disease, tuberculosis, and syphilis. In persistent cases, sphincter repair operations may be necessary to cure incontinence, according to Drs. George Y. Wu et al in “An Internist’s Illustrated Guide to Gastrointestinal Surgery.”

    Abscesses and Fistulas

    • When abscesses and fistulas occur, they usually do so together. Abscesses are small collections of pus that form in response to an infection. They occur in less than one percent of LIS patients and can be removed, according to Drs. Mulholland and Doherty. These doctors go on to say that fistulas are the abnormal connection of two epithelial lined structures – essentially a hole within the body that shouldn’t be there. Fistulas occur in 30 percent to 70 percent of patients that have abscesses. Further procedures will be required to treat these conditions - including drainage of the abscess and possibly a surgical procedure called a fistulotomy.

    Long Term Results

    • A study of 585 LIS patients from 1984 to 1996 showed that LIS surgery relieved anal fissure symptoms within three weeks in 96 percent of the patients. The study, published in the journal “Diseases of the Colon and Rectum” in 1999 by doctors from the Mayo Clinic, went on to say that incontinence was the most prevalent complication. However, while 45 percent of the patients said they dealt with incontinence at some point in the five years after surgery, only three percent said it affected their quality of life. Ultimately, the benefits and consequences of LIS surgery should be discussed with a doctor that can help you decide whether LIS is for you.

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