Lateral Internal Sphincterotomy
What is Lateral Internal Sphincterotomy?
Lateral internal sphincterotomy (LIS) is a surgical procedure to treat chronic anal fissures by making a small incision in the internal anal sphincter muscle to reduce sphincter pressure, improve blood flow, and promote healing of the fissure. It is a highly effective treatment for fissures that do not respond to non-surgical therapies. In India, LIS is performed in specialized colorectal surgery centers, offering affordable, high-quality care. For patients and families in India, understanding the procedure, costs, recovery, risks, and frequently asked questions (FAQs) is essential for informed decision-making and optimal outcomes.
Why do you need Lateral Internal Sphincterotomy?
Anal fissures are painful tears in the anal canal lining, often caused by trauma from hard stools, chronic constipation, or diarrhea. Chronic fissures (lasting >6–8 weeks) develop scar tissue and are associated with high anal sphincter pressure, impairing healing. LIS is indicated for:
- Chronic anal fissures: Persistent pain, bleeding, or sentinel tags after failed conservative treatments (e.g., high-fiber diet, sitz baths, topical nitroglycerin, or Botox injections).
- Recurrent fissures: Repeated episodes despite medical management.
- Fissures with high sphincter tone: Confirmed by clinical exam or anorectal manometry.
- Severe symptoms: Significant pain or bleeding impacting quality of life.
In India, hospitals like Apollo, Fortis, Medanta, and Narayana Health specialize in LIS, often performing it as a day-care procedure using open or closed techniques.
Why Do Lateral Internal Sphincterotomy Costs Vary in India?
The cost of Lateral Internal Sphincterotomy (LIS) in India ranges from ₹25,000 to ₹1.2 lakh, depending on:
- Procedure Type:
- Standard open/closed LIS: ₹25,000–₹70,000
- LIS with fissurectomy: ₹50,000–₹1 lakh
- Advanced centers with specialized anesthesia: Higher costs
- Hospital & Location: Top hospitals in metro cities (e.g., Apollo, Fortis) charge more; government hospitals (e.g., AIIMS) cost ₹10,000–₹40,000 but may have wait times.
- Specialist Expertise: Experienced colorectal surgeons charge higher fees.
- Extra Costs: Diagnostics (anoscopy, blood tests), anesthesia, medications, or rare complications (e.g., infection) add to expenses.
- Insurance & Aid: Many insurance plans cover LIS for chronic/symptomatic fissures; Ayushman Bharat offers free or subsidized treatment at empanelled hospitals.
Lateral Internal Sphincterotomy Procedure
LIS is a quick, minimally invasive procedure typically performed as an outpatient surgery:
- Before Procedure Evaluation:
- Diagnosis is confirmed via:
- Physical examination: Identifies the fissure, sentinel tag, or hypertrophied papillae.
- Anoscopy: Visualizes the internal anal canal to confirm the fissure’s location and exclude other conditions (e.g., fistulas, hemorrhoids).
- Anorectal manometry (rarely): Measures sphincter pressure in complex cases.
- Blood tests ensure surgical fitness, particularly for patients with comorbidities.
- Bowel preparation (enemas or laxatives) may be advised to reduce contamination.
- Patients are counseled on post-operative pain, hygiene, and the small risk of incontinence.
- Diagnosis is confirmed via:
- Surgical Technique:
- Open Lateral Internal Sphincterotomy:
- Performed under general, spinal, or local anesthesia with sedation, lasting 15–30 minutes.
- The patient is positioned in the lithotomy (legs raised) or prone position.
- A small incision is made laterally (at the 3 or 9 o’clock position) in the anal canal, away from the fissure (typically posterior at 6 o’clock).
- The internal anal sphincter is partially divided (up to 1 cm or the fissure’s length) to reduce pressure, leaving the external sphincter intact to preserve continence.
- The wound is left open to heal naturally, and the fissure may be left untreated or gently curetted.
- Closed Lateral Internal Sphincterotomy:
- A similar approach but uses a small stab incision, through which a scalpel divides the sphincter under palpation guidance, minimizing tissue trauma.
- The incision is closed with a suture, reducing bleeding risk.
- Preferred in some centers for its cosmetic outcome and slightly lower infection risk.
- Fissure Management:
- The fissure itself is usually left to heal naturally post-sphincterotomy, though some surgeons perform a concurrent fissurectomy (excision of scar tissue) for chronic cases.
- The procedure is typically outpatient, with same-day discharge unless complications arise.
- Open Lateral Internal Sphincterotomy:
- After Procedure:
- Patients are monitored for a few hours to ensure recovery from anesthesia and pain control.
- Pain medications (e.g., paracetamol, ibuprofen) and stool softeners (e.g., lactulose) ease bowel movements and reduce strain.
- Sitz baths (warm water soaks) 2–3 times daily promote healing and reduce discomfort.
- Follow-up visits assess fissure healing and bowel function.
Recovery After Lateral Internal Sphincterotomy
Recovery is rapid but requires diligent care to ensure healing and prevent complications:
- Hospital Stay:
- Most patients are discharged the same day (outpatient) or within 24 hours.
- Rarely, a 1-day stay is needed for pain management or monitoring.
- Post-Procedure Care:
- Pain is significant for the first 3–7 days, especially during bowel movements, managed with oral painkillers, sitz baths, and topical anesthetics (e.g., lignocaine).
- Stool softeners and high-fiber diets prevent constipation and reduce strain.
- The anal area must be kept clean and dry; patients are advised to shower after bowel movements or use wet wipes.
- Antibiotics are rarely needed unless infection is present.
- Activity and Diet:
- Light activities (e.g., walking) resume within 1–2 days; strenuous activities (e.g., heavy lifting, sports) are avoided for 2–3 weeks.
- A high-fiber diet (fruits, vegetables, whole grains) and 2–3 liters of water daily promote soft stools.
- Avoid spicy foods, alcohol, or caffeine, which may irritate the bowels or worsen pain.
- Follow-Up:
- Follow-up visits at 1–2 weeks and 4–6 weeks assess fissure healing and bowel function.
- The fissure typically heals within 2–6 weeks, with pain subsiding significantly by 1–2 weeks.
- Long-term follow-ups are rare unless incontinence or recurrence occurs.
Most patients resume normal activities within 1–2 weeks, with healing rates of 95–98%. Recurrence is rare (1–5%) with proper surgery and lifestyle changes.
Risks and Complications
LIS is a low-risk procedure but carries potential complications:
- Surgical Risks:
- Bleeding, usually minor but rarely requiring intervention.
- Infection at the incision site, treated with antibiotics or drainage.
- Sphincter-Related Risks:
- Fecal incontinence (1–10%), typically minor (e.g., gas leakage, occasional soiling), and often temporary. Permanent incontinence is rare (<1%) with controlled sphincter division.
- Incomplete sphincter relaxation, leading to fissure persistence or recurrence (1–5%).
- General Risks:
- Adverse reactions to anesthesia.
- Delayed healing in patients with comorbidities (e.g., diabetes, Crohn’s disease).
- Long-Term Issues:
- Anal stenosis (rare), requiring dilatation.
- Chronic discomfort, uncommon with proper technique.
Prompt reporting of symptoms like excessive bleeding, fever, or incontinence ensures timely management.
Frequently Asked Questions (FAQs)
What causes chronic anal fissures requiring LIS?
Chronic fissures result from trauma (e.g., hard stools), high sphincter pressure, or poor blood flow, often persisting beyond 6–8 weeks.
Can anal fissures heal without surgery?
Acute fissures often heal with high-fiber diets, sitz baths, or medications. Chronic fissures usually require LIS or other interventions (e.g., Botox) if conservative treatments fail.
Is LIS better than other fissure treatments?
LIS has a higher healing rate (95–98%) than Botox (60–80%) or topical treatments and is the gold standard for chronic fissures, though it carries a small incontinence risk.
How soon can I resume normal activities?
Light activities resume in 1–2 days; normal routines (work, driving) resume in 1–2 weeks.
Is LIS covered by insurance in India?
Most insurance plans cover LIS for chronic or symptomatic fissures. Confirm with your provider.
What are the signs of complications post-LIS?
Excessive bleeding, fever, severe pain, or difficulty controlling bowel movements require immediate medical attention.
Can fissures recur after LIS?
Recurrence is rare (1–5%) with proper surgery, but persistent constipation or straining increases the risk.
What lifestyle changes are needed post-LIS?
Maintain a high-fiber diet, stay hydrated, avoid straining during bowel movements, and practice good anal hygiene to prevent recurrence.
Conclusion
Lateral internal sphincterotomy is a highly effective, low-risk procedure for treating chronic anal fissures, offering rapid pain relief and near-complete healing. With expertise in hospitals like Apollo, Fortis, and AIIMS, India provides affordable, high-quality colorectal care. By understanding the procedure, cost variations, recovery, risks, and FAQs, patients can approach LIS with confidence. For personalized guidance, consult a colorectal surgeon at a reputed hospital to ensure timely and successful treatment.
Looking for Best Hospitals for Lateral Internal Sphincterotomy
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we are not promoting any hospitals we sourced all the details from google and hospitals website, please verify and start with your surgery here we go the list includes government, budget and superspeciality hospitals accreditation bodies are the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and the Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₹) | Maximum Price (₹) |
|---|---|---|
Agra |
30,000 |
90,000 |
Ahmedabad |
35,000 |
1,00,000 |
Ajmer |
30,000 |
90,000 |
Aligarh |
30,000 |
90,000 |
Allahabad |
30,000 |
90,000 |
Amritsar |
32,000 |
95,000 |
Aurangabad |
32,000 |
95,000 |
Bangalore |
35,000 |
1,00,000 |
Bareilly |
30,000 |
90,000 |
Belgaum |
32,000 |
95,000 |
Bhopal |
32,000 |
95,000 |
Bhubaneswar |
32,000 |
95,000 |
Bikaner |
30,000 |
90,000 |
Chandigarh |
35,000 |
1,00,000 |
Chennai |
35,000 |
1,00,000 |
Coimbatore |
35,000 |
1,00,000 |
Dehradun |
32,000 |
95,000 |
Delhi |
35,000 |
1,00,000 |
Dhanbad |
30,000 |
90,000 |
Durgapur |
30,000 |
90,000 |
Faridabad |
35,000 |
1,00,000 |
Ghaziabad |
35,000 |
1,00,000 |
Gorakhpur |
30,000 |
90,000 |
Guntur |
32,000 |
95,000 |
Gurgaon |
35,000 |
1,00,000 |
Guwahati |
32,000 |
95,000 |
Gwalior |
30,000 |
90,000 |
Hyderabad |
35,000 |
1,00,000 |
Indore |
32,000 |
95,000 |
Jabalpur |
30,000 |
90,000 |
Jaipur |
35,000 |
1,00,000 |
Jalandhar |
32,000 |
95,000 |
Jamshedpur |
32,000 |
95,000 |
Jodhpur |
30,000 |
90,000 |
Kanpur |
30,000 |
90,000 |
Kochi |
35,000 |
1,00,000 |
Kolkata |
35,000 |
1,00,000 |
Kollam |
32,000 |
95,000 |
Lucknow |
32,000 |
95,000 |
Ludhiana |
35,000 |
1,00,000 |
Madurai |
32,000 |
95,000 |
Mangalore |
32,000 |
95,000 |
Meerut |
30,000 |
90,000 |
Moradabad |
30,000 |
90,000 |
Mumbai |
35,000 |
1,00,000 |
Mysore |
35,000 |
1,00,000 |
Nagpur |
32,000 |
95,000 |
Nashik |
32,000 |
95,000 |
Navi Mumbai |
35,000 |
1,00,000 |
Noida |
35,000 |
1,00,000 |
Patna |
30,000 |
90,000 |
Pune |
35,000 |
1,00,000 |
Raipur |
32,000 |
95,000 |
Rajkot |
32,000 |
95,000 |
Ranchi |
30,000 |
90,000 |
Surat |
35,000 |
1,00,000 |
Thane |
35,000 |
1,00,000 |
Vadodara |
32,000 |
95,000 |
Varanasi |
30,000 |
90,000 |
Visakhapatnam |
32,000 |
95,000 |
Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.