Objective:

To evaluate the long-term safety and efficacy of lateral internal sphincterotomy (LIS) for chronic anal fissure and address concerns regarding postoperative incontinence.

Key Findings:

• LIS remains the gold standard for chronic anal fissure treatment.
• Strict candidate selection enhances the reliability of continence outcomes.
• Postoperative incontinence may overlap with natural age-related decline in anorectal function.
• Time-segmented reporting could provide clearer insights into the transient nature of incontinence.
• Patient satisfaction remains favorable despite documented incontinence rates.

Interpretation:

The study supports the long-term safety of LIS when performed with strict indications, but highlights the need for improved definitions and reporting methods to better inform patient outcomes.

Limitations:

• Lack of consensus on incontinence definitions may skew results.
• Absence of time-stratified outcome reporting could exaggerate long-term risk perception.
• Limited incorporation of patient-reported outcomes may overlook the psychosocial impact.

Conclusion:

Future research should focus on standardized definitions, time-specific reporting, and patient-reported outcomes to refine risk estimates and enhance patient counseling.