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Incontinence After Lateral Internal Sphincterotomy/Fistulotomy

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Gastrointestinal Surgery

Abstract

Incontinence is defined as the involuntary loss of fecal material and/or gas through the anal canal and may range widely in severity. Normal continence is maintained by a complex interaction of the anal sphincter muscles and pelvic floor innervation. Sphincterotomy and/or fistulotomy may result in unintended disruption of the anal sphincter complex with subsequent incontinence. Lateral internal sphincterotomy (LIS) and fistulotomy are very effective treatments for chronic anal fissure (CAF) and fistula, respectively, with various techniques described for both. Varying degrees of success and rates of incontinence have also been reported for both procedures. Preoperative studies including anal manometry, endoanal ultrasonography, and/or MRI should be considered in individuals at increased risk of incontinence. Should continence issues develop postoperatively, significant symptomatic improvement may be achieved with conservative methods such as fiber and/or antidiarrheal agents. Biofeedback may be used if conservative management fails. For those individuals in whom conservative management fails, other options including injectables or implants may be appropriate to manage the incontinence.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota Medical School, Saint Paul, MN, USA

    Asst. Prof. Heather Rossi MD

  2. Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA

    Prof. David Rothenberger MD

Authors
  1. Asst. Prof. Heather Rossi MD
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  2. Prof. David Rothenberger MD
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Correspondence to David Rothenberger MD .

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Editors and Affiliations

  1. Division of Surgical Oncology, Johns Hopkins Hospital, Baltimore, Maryland, USA

    Timothy M. Pawlik

  2. Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA

    Shishir K. Maithel

  3. Professor of Surgery, Division of Surgical Oncology, University of Miami, Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida, USA

    Nipun B. Merchant

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Rossi, H., Rothenberger, D. (2015). Incontinence After Lateral Internal Sphincterotomy/Fistulotomy. In: Pawlik, T., Maithel, S., Merchant, N. (eds) Gastrointestinal Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2223-9_43

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  • DOI: https://doi.org/10.1007/978-1-4939-2223-9_43

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