Health and quality of life among a cohort of patients having Lateral Internal Sphincterotomy for anal fissures

AIM The aim of this study is to report changes in health-related quality of life attributable to lateral internal sphincterotomy for treatment of anal fissures. There is very little evidence regarding whether patients' overall health-related quality of life is detrimentally affected by the condition, nor which aspects of self-perceived health status improve attributable to lateral internal sphincterotomy. This study will articulate which aspects of health tend to improve and guide postoperative expectations appropriately. The knowledge from this study may also identify gaps in an individual patient's episode of care. METHOD Patients are prospectively identified when they consent to surgical treatment of their anal fissure and are contacted by phone to participate. Participants complete a number of patient-reported outcomes preoperatively and six months postoperatively. Faecal incontinence-related quality of life, pain, and depression are measured at both time points. Faecal incontinence severity is measured at both times. RESULTS Participants reported high levels of pain preoperatively. Postoperatively, improvement in pain exceeded the threshold of clinical relevance (p < 0.01). 35% of participants reported significant effects of faecal incontinence pre-operatively, while 26% did so postoperatively. Participants with multiple comorbidities were more likely to report faecal incontinence postoperatively than preoperatively. CONCLUSIONS This study reports that lateral internal sphincterotomy improved pain symptoms without adverse effects on continence. Not all domains of health-related quality of life were similarly positively affected by anal fissure repair.