Hello, several years ago I had an Open Lateral Internal Sphincterotomy done to address a chronic fissure. I'm told by a different surgeon that the sphincterotomy left me w/a Keyhole Deformity, which is causing the incontinence. Does anyone have this same deformity as a result of this surgery? Does anyone know what can be done to correct it?

DRKJR,

I'm sorry to hear that your sphincterotmy has left you with this problem. You say that you have a Keyhole Deformity, this deformity is caused when the incision is made in the posterior edge (the back edge of your anus, not off to the left or right side). This more than likely means that you did not have a LATERAL (off to the side, either the left or right) sphincterotomy. How many years ago was it when you had your surgery for this? I am asking because not too many years back the decision was made to start making the incision for a sphincterotomy laterally, off to the side, because the anterior and posterior rectal muscles are not very strong, which is one of the reasons fissures are usually in the anterior (12 o'clock position) or the posterior (6 o'clock position). For that reason they discovered that when the incision was made in the posterior it eventually caused a "Keyhole Deformity" resulting in incontinence. Basically, your scar looks like an old-fashioned keyhole, the type skeleton keys fit in. This leaves a sort of "opening" that fecal matter and stool can leak out through and because the incision was made in that area, an already weak musce area, the muscle becomes even more weakened. I had a fissure last year and suffered horrifically for 8 months then finally decided to have the LIS surgery. I did a lot of research on the surgery and read many medical journals and articles about this deformity while doing my research and they scared me but I asked many doctors about this and they all confirmed that a sphincterotomy incision made anywhere but to the left or right side is not being properly performed and that procedure is old school. My surgery was a complete success as many I have read about are. I did read that some people who suffer from incontinence have decided to have a procedure performed to correct the deformity. I believe it is called a Sphincteroplasty. They basically cut the two ends of the muscle and sew them back together overlapping so they heal to form a complete muscular ring again establishing muscle control thus controlling the incontinence. Have you discussed treatment options with your current doctor? Keep us posted.

Hey Purple, thanks for the quick reply. Anyway, I had the surgery in 1998. The name of the operation on my medical records is Lateral Sphincterotomy, Biopsy of Fissure and Proctoscopy. I've seen several other colo-rectal surgeons in the past nine years, and none of them will say that I actually had a posterior sphincterotomy. One was very confident that I had developed a keyhole deformity. Another asked me how old the person was who did the surgery (this might go back to the old school comment you made.) I had a sphincteroplasty done two years ago, and it reduced the incontinence quite a bit, but I still have the problem. That surgeon commented after the surgery that the gap she needed to repair was "very large." I've read that an Open LIS, as opposed to a Closed LIS, can lead to keyhole deformity. It's possible that this is what was done to me. The med records from one surgeon I saw says there is "evidence of a totally transected internal sphincter." Do you know what this means exactly???