What are possible surgical complications from treatment of anal fissure?

Updated: Jul 24, 2020
  • Author: Lisa Susan Poritz, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Complications from surgery for anal fissure include the following:

  • Infection
  • Bleeding
  • Fistula development
  • Incontinence (the most feared complication)

Infection after sphincterotomy is rare and occurs as a small abscess in only 1-2% of patients, despite the inherent uncleanliness of the area. Treatment is drainage of the abscess. Antibiotics are necessary only if significant associated cellulitis occurs or if the patient is immunosuppressed.

Some ecchymosis may occur around the sphincterotomy site, but bleeding that necessitates therapy is extremely rare.

Fewer than 1% of patients develop an anal fistula at the site of the sphincterotomy. This usually results from a breach of the mucosa at the time of the sphincterotomy. The fistula is often low and superficial and should be treated with fistulotomy.

The incidence and definition of incontinence vary dramatically from study to study and among the different procedures. Of patients undergoing the sphincter stretch, 12-27% report problems with continence after the procedure. This is most likely because this is an uncontrolled stretch of the anal sphincter and because both the internal and external sphincters are stretched.

Incontinence rates are much lower with a properly performed internal sphincterotomy than with sphincter stretch, though these rates depend on the definition of incontinence being applied. In most patients, the minor soiling or incontinence to flatulence that may occur in the immediate postoperative period usually resolves without any long-term sequelae.

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