Skip to content
Beverly Hills · 435 N. Bedford Dr., Suite 308Mon–Fri 9:00 am – 5:00 pmMost PPO insurance accepted
Allen KamravaMD · MBA · FACS · FASCRS

Procedure

Operative

Lateral Internal Sphincterotomy (LIS)

A small, precise release of the overly tight sphincter muscle — the most dependable operation we have for a chronic fissure that hasn't healed with medicine.

Request a consultationSurgery is arranged with a coordinator by phone.
Setting
Operative
Anesthesia
Brief general anesthesia or sedation, as an outpatient — home the same day
Back to work
Most patients are back to normal daily activities within a few days
Pain relief
Warm sitz baths and over-the-counter pain relievers are usually enough
Success rate
90-98%
Recurrence
2-8%

What it is

What is a Lateral Internal Sphincterotomy?

A Lateral Internal Sphincterotomy (LIS) is a surgical procedure considered the gold standard for treating chronic anal fissures that have not responded to medical therapies. The procedure involves making a small, precise incision in the internal anal sphincter muscle. This division helps to release the chronic spasm and hypertonicity of the muscle, which in turn reduces anal pain, improves blood flow to the fissure, and allows the fissure to heal.

Am I a candidate?

Who is a Good Candidate for LIS?

LIS is the ideal treatment for patients with chronic anal fissures associated with a hypertonic internal anal sphincter who have failed at least 6-8 weeks of conservative medical management, such as topical creams (calcium channel blockers or nitrates) and lifestyle modifications. It is best for patients with severe, debilitating pain who are seeking a definitive and highly effective long-term solution.

How it's done

  1. 1Anesthesia — a brief general anesthetic or sedation in the operating room. This is an outpatient procedure; you go home the same day.
  2. 2Through a very small incision at the side of the anus, the lower portion of the internal sphincter muscle is divided — a release measured in millimeters, nothing more.
  3. 3That precise release ends the muscle spasm, restores blood flow to the fissure, and lets it finally heal.
  4. 4The incision is tiny — closed with a dissolving stitch or left to heal on its own. There is no wound packing.

What to expect

  1. Same day

    Home within a few hours.

  2. First days

    Many patients notice the fissure pain itself easing quickly — the incisional soreness is often milder than the pain they came in with. Sitz baths and over-the-counter relievers usually cover it.

  3. A few days

    Most people are back to work and normal daily activities.

  4. Following weeks

    For the great majority of patients, the fissure heals as the spasm stays released. Fiber and fluids keep stools soft so nothing re-tears.

  5. Follow-up

    A visit to confirm the fissure has healed.

Risks & considerations

What are the Risks?

While LIS has a very high success rate, it carries a small but significant risk of complications, which must be carefully considered. The primary risks include:

  • Pain: Some incisional pain is expected but is typically much less severe than the pain from the fissure itself and resolves within a few days.
  • Bleeding or Hematoma: Minor bleeding can occur. A small hematoma at the incision site may cause a painful lump but usually resolves on its own.
  • Infection or Abscess: Infection at the surgical site is uncommon but possible.
  • Fecal Incontinence: This is the most significant risk. A small percentage of patients (ranging from 0-30% in studies) may experience minor, and often temporary, difficulty controlling gas or minor soiling. Permanent, significant incontinence is rare when the procedure is performed correctly, but the risk is higher in women with prior obstetric injuries or individuals with pre-existing borderline continence.
  • Recurrence: While rare, the fissure may fail to heal or can recur over time.

The risks that matter

Every operation carries a long list of possible complications. These are the ones that are serious enough — and common enough — to understand in real numbers before you decide.

Fecal Incontinence

Loss of the ability to control your stool. This is a permanent change that can not be reversed.

1-8%— roughly 1 in a hundred to 1 in 12
Why it happens
Sphincterotomy is a cutting of the anal sphincter muscles. Once the muscle is cut, there isn't a procedure at moment that we have to reconnect the sphincters.
How we lower the odds
Non-operative methods for treating anal fissure are highly effective - fiber, water, and ointments.

Lowering the odds is not the same as removing them. Even when everything is done right, this can still happen — that is the nature of the operation, not a failure of your care.

Sources

CallBook