Lateral Internal Sphincterotomy Surgery in Delhi, India

A lateral internal sphincterotomy is a surgical procedure performed to treat chronic anal fissures that do not heal with medication or lifestyle changes. An anal fissure is a tear in the lining of the anal canal, leaving the surrounding muscles vulnerable to spasms. This prevents the wound from healing and causes intense pain and tension, especially during bowel movements. Left untreated, the muscles tend to increase in size, further widening the anal fissure.

Lateral internal sphincterotomy involves dividing the internal anal sphincter muscle (sphincterotomy) from the side (laterally). It helps reduce tension, improve blood flow, and promote healing of the fissure. By relieving excessive pressure in the anal canal, this procedure effectively reduces pain and prevents recurrent fissures.

The key benefits of a lateral internal sphincterotomy include:

• Pain Relief: By reducing muscle tension, the procedure significantly alleviates discomfort.
• Faster Healing: Improved blood circulation helps the fissure heal more effectively.
• Prevention of Recurrence: Lowering sphincter pressure reduces the chances of fissures reappearing.
• Minimally Invasive Solution: A quick and effective surgical approach with a high success rate.

Both fissurectomy and lateral internal sphincterotomy are surgical procedures used to treat chronic anal fissures, but they differ in approach and purpose.

A fissurectomy involves the removal of the anal fissure along with any surrounding scar tissue to allow fresh tissue to heal properly. This procedure is often recommended when the fissure is accompanied by excess fibrotic tissue, skin tags, or an underlying infection. While effective, fissurectomy alone does not address the underlying cause of the fissure—high sphincter muscle tension.

In contrast, a lateral internal sphincterotomy directly addresses the root cause of chronic fissures by making a controlled incision in the internal anal sphincter muscle. This reduces excessive pressure in the anal canal, allowing fissures to heal naturally and preventing recurrence.

In many cases, lateral internal sphincterotomy is performed alongside other procedures. Depending on the patient’s condition, surgeons may also perform a haemorrhoidectomy to remove haemorrhoids, a fissurectomy to repair anal tears, or a fistulotomy to treat anal fistulas. At Max Hospitals, our expert surgeons carefully evaluate each case to recommend the most effective treatment approach, ensuring optimal healing and minimal discomfort.

Lateral Internal Sphincterotomy offers numerous benefits for individuals suffering from chronic anal fissures, providing long-term relief and improving overall quality of life. Here’s how this procedure can help:

• Long-Term Relief from Chronic Anal Fissures: Lateral Internal Sphincterotomy is one of the most effective treatments for chronic anal fissures, providing lasting relief by reducing sphincter muscle tension and improving blood flow to the affected area.
• High Success Rate: The procedure boasts a high success rate, with most patients experiencing complete healing within a few weeks. It significantly lowers the chances of fissure recurrence compared to non-surgical treatments.
• Quick and Minimally Invasive Procedure: Lateral Internal Sphincterotomy is a short surgical procedure that typically takes 15-30 minutes. It is performed under local, regional, or general anaesthesia, ensuring minimal discomfort during the surgery.
• Faster Recovery Time: Compared to other surgical interventions, the recovery time for lateral internal sphincterotomy is relatively short. Most patients can resume daily activities within one to two weeks, with proper post-operative care.
• Immediate Pain Relief: Many patients report a significant reduction in pain almost immediately after surgery, as the procedure alleviates excessive pressure on the anal sphincter, which is the primary cause of discomfort.
• Minimal Risk of Complications: While all surgeries carry some risk, lateral internal sphincterotomy is considered safe, with low complication rates when performed by experienced colorectal surgeons.
• Improved Quality of Life: By eliminating persistent pain, discomfort, and bleeding, the procedure helps patients return to their normal routine, free from the distress caused by chronic fissures.

A lateral internal sphincterotomy is typically recommended for patients who:

• Experience persistent pain and bleeding during bowel movements.
• Have an anal fissure that has lasted for more than six weeks despite non-surgical treatments.
• Have recurring fissures that frequently return after temporary healing.
• Have anal sphincter hypertonicity, where the sphincter muscle remains too tight, preventing proper healing.
• Are suffering a significant decline in their quality of life, making daily activities uncomfortable.

However, not everyone is an ideal candidate for lateral internal sphincterotomy. Patients with weakened anal sphincter muscles, underlying bowel diseases such as Crohn’s disease, or a history of faecal incontinence may need alternative treatment options.

At Max Hospitals, our specialists conduct a thorough evaluation to determine the best treatment plan for each patient, ensuring safe and effective relief tailored to their needs.

At Max Hospitals, we offer advanced lateral internal sphincterotomy techniques tailored to each patient’s condition. Our experienced surgeons utilise modern, minimally invasive approaches to ensure effective treatment with reduced discomfort and faster recovery. The primary types of sphincterotomy procedures performed at our hospital include:

• Traditional Open Lateral Internal Sphincterotomy: In this method, the incision in the internal sphincter muscle fibres is made through an external incision on the skin near the anal area. The muscle fibres are separated with thermal cautery or knife and typically left open to heal naturally or sutured depending on the patient’s condition.
• Closed Lateral Internal Sphincterotomy: In the closed technique, a small incision is made in the groove between the external and internal anal sphincters using a surgical blade and then the muscle fibres of the internal anal sphincter is divided.
• Laser Sphincterotomy: For patients seeking a minimally invasive alternative, laser sphincterotomy offers a precise and efficient option. This procedure involves using a high-energy laser to divide the sphincter muscle with minimal bleeding and tissue damage. Laser technology ensures faster healing, reduced risk of complications, and less postoperative pain.

At Max Hospitals, we follow a structured and patient-centric approach to ensure a safe and effective lateral internal sphincterotomy procedure. From preoperative preparation to post-surgery care, every step is designed to enhance recovery and minimise discomfort.

Before the Procedure

Before undergoing a lateral internal sphincterotomy, patients go through a detailed evaluation to confirm the diagnosis and assess their overall health. Key preoperative steps include:

• Medical Assessment: A thorough examination, including a review of symptoms and medical history, to determine the severity of the anal fissure.
• Diagnostic Tests: Tests like anoscopy or sigmoidoscopy are performed to evaluate the anal canal.
• Preoperative Instructions: Patients may be advised to avoid food and liquids a few hours before surgery and temporarily discontinue certain medications as per the doctor's guidance.
• Bowel Preparation: A mild laxative or enema may be prescribed to clear the bowels before surgery, ensuring a smooth procedure.

During the Procedure

The lateral internal sphincterotomy surgery is typically a quick and minimally invasive procedure performed under local, spinal, or general anaesthesia, depending on the patient's condition. Key steps include:

• Locating the Anal Fissure: The surgeon will use an anoscope to locate the anal fissure within the anal canal.
• Incision: Depending on whether an open or closed sphincterotomy technique is chosen, a small cut is made on the external anal skin or directly between the groves of the sphincters. This relaxes the sphincter muscle, reducing pressure in the anal canal and promoting healing.
• Closure or Natural Healing: Depending on the need, the incision may be left to heal naturally or sutured.
• Additional Procedures: If required, the surgery may be combined with a fissurectomy or hemorrhoidectomy for comprehensive treatment.
• Completion: Once the procedure is complete, patients are monitored for a brief period before discharge.

After the Procedure

Recovery from a lateral internal sphincterotomy is usually quick, with most patients resuming light activities within a few days. It is normal to feel sore in the initial few days post-surgery. Patients can also expect fluid discharge or bleeding from the anus during this period. Key postoperative steps include:

• Pain Management: Mild discomfort is common, which can be managed with prescribed pain relievers and warm sitz baths.
• Bowel Care: A high-fibre diet and adequate hydration are recommended to prevent constipation and promote healing.
• Hygiene & Wound Care: Keeping the surgical site clean and dry is essential to prevent infection.
• Follow-up Appointments: Regular check-ups ensure proper healing and recovery progress.
• Expected Recovery Timeline: Most patients experience significant relief from fissure-related pain within a week, with complete healing typically occurring within 6 to 8 weeks.

While lateral internal sphincterotomy is a highly effective and safe procedure, like any surgery, it carries some risks. At Max Hospitals, our expert colorectal surgeons take every precaution to minimise complications and ensure a smooth recovery. Should any complications arise, we are equipped with advanced medical care to manage them effectively.

Postoperative Pain and Discomfort

• Mild pain is common after surgery, but it usually subsides within a few days.
• We provide effective pain management, including prescription pain relievers and warm sitz baths to ease discomfort.

Bleeding

• Some minor bleeding may occur in the first few days post-surgery.
• If excessive or prolonged, our team conducts thorough postoperative monitoring and interventions to control bleeding.

Infection

• Though rare, infections can occur at the surgical site.
• We ensure strict hygiene protocols, prescribe antibiotics when necessary, and provide proper wound care to prevent and manage infections.

Temporary Faecal Incontinence (Gas or Stool Leakage)

• A temporary loss of control over gas or mild stool leakage may occur in some patients.
• This usually resolves as the muscles heal, and we provide pelvic floor therapy and dietary guidance to aid recovery.

Fissure Recurrence

• In rare cases, the fissure may return if the underlying cause is not fully addressed.
• We focus on comprehensive treatment plans, including dietary modifications, lifestyle changes, and follow-up care to prevent recurrence.

Anal Stenosis (Narrowing of the Anal Canal)

• Scar tissue formation may lead to anal stenosis in some cases.
• At Max Hospitals, we offer minimally invasive treatments, including dilation therapy or additional surgical correction if needed.

Delayed Healing

• Factors like poor nutrition, chronic constipation, or underlying medical conditions can slow the healing process.
• Our specialists provide personalised recovery plans, including fibre-rich diets, hydration tips, and stool softeners to aid healing.

While lateral internal sphincterotomy is a safe and effective procedure, it’s essential to monitor your recovery and seek medical attention if any unusual symptoms arise.

• Excessive Bleeding: Light bleeding is normal in the first few days, but if a patient experiences heavy bleeding that doesn’t stop or sees large blood clots, consult a doctor immediately.
• Severe or Worsening Pain: Mild discomfort is expected, but intense, persistent pain that isn’t relieved by prescribed medication could indicate an infection or improper healing.
• Signs of Infection: Symptoms such as fever, chills, increased redness, swelling, warmth, or pus discharge around the surgical site require prompt medical evaluation.
• Difficulty Passing Stool or Urine: Severe constipation, difficulty urinating, or extreme pain during bowel movements may indicate a complication that needs medical attention.
• Uncontrolled Stool or Gas Leakage: While mild stool or gas leakage is common initially, persistent incontinence beyond the recovery period should be discussed with your doctor.
• Delayed Wound Healing: If the incision doesn’t heal properly or continues to bleed or remain open after the expected recovery period, a follow-up is necessary.

At Max Hospitals, we are committed to providing world-class gastrointestinal and colorectal care with a patient-first approach. If you or someone you know is struggling with chronic anal fissures or related conditions, trust Max Hospitals for the highest standard of sphincterotomy surgery and holistic patient care.

Why would someone need a lateral internal sphincterotomy?

Lateral internal sphincterotomy is recommended for chronic anal fissures that do not heal with conservative treatments, providing long-term pain relief and healing.

Is anaesthesia given during a lateral internal sphincterotomy?

Yes, lateral internal sphincterotomy is performed under either local, spinal, or general anaesthesia to ensure patient comfort during the procedure.

How painful is a lateral internal sphincterotomy?

Mild discomfort is expected after the surgery, but pain is usually manageable with prescribed medications and subsides within a few days.

How to prepare for a lateral internal sphincterotomy?

Doctors may advise dietary adjustments, fasting before surgery, and stopping certain medications to ensure a smooth procedure and recovery.

How long does it take to heal from lateral internal sphincterotomy?

Most patients recover within 4 to 6 weeks, though relief from fissure pain is often felt within a few days after surgery.

What happens when sphincterotomy doesn't work?

If symptoms persist after surgery, additional treatments such as medications, dietary changes, or, in rare cases, revision surgery may be required.

How do you poop after a lateral internal sphincterotomy?

Stool softeners, fibre-rich foods, and plenty of fluids help ensure smooth bowel movements and prevent strain during recovery.

Does sphincterotomy cause permanent incontinence?

Temporary mild leakage of gas or stool may occur, but permanent incontinence is rare when the procedure is performed correctly.

What to eat after sphincterotomy?

A high-fibre diet, including fruits, vegetables, and whole grains, along with plenty of water, helps promote healing and prevent constipation.

Reviewed by Dr. Asit Arora, Senior Director, Surgical Oncology, Cancer Care / Oncology, Gastrointestinal & Hepatobiliary Oncology, Gastro Intestinal & Hepatopancreatobiliary Surgical Oncology, Robotic Surgery, on 08 September 2025.