Laser fissure
surgery

What is an anal fissure?

An anal fissure is a tear around the lining of the anal canal. Anal fissures occur with painful ulcers at the end of anal canal.

Anal fissures cause pain and bleeding during defecation and continue to hurt even after several hours of defecation.

What are the factors contributing to

anal fissures?

Following factors result in anal fissures:

  • Passing hard stools resulting in the damage of the lining in the anal canal.
  • Muscle tone increase in the anal canal
  • Reduction in nitric oxide synthesis which is responsible for facilitating relaxation of the internal anal muscles.

What is fissure surgery or

sphincterotomy?

A sphincterotomy is a surgical procedure used to treat anal fissures.

When other methods of treatment fail then the doctors recommend sphincterotomy for fissure surgery.

The surgical methods to treat anal fissures are as follows:

  • Lateral internal sphincterotomy
  • Fissurectomy
  • V-Y advancement flap

Under what circumstances is

sphincterotomy performed?

Sphincterotomy is performed under the following circumstances:

  • When there is chronic anal fissures and the pain is uncontrollable
  • Complicated fissures due to underlying  infected fistula
  • Bleeding in the anal region
  • Prior medical complications resulting in fissures

What are the symptoms of

anal fissures?

Following are the symptoms of fissures:

  • Blood in the stools
  • A small lump near the skin in the anal area
  • Pain while passing stools
  • Pain for several hours after passing stools that keeps increasing and recurring

What are the Non-surgical remedies available

for fissures?

Surgery is required in very few cases, unless the fissures are not chronic in nature and mild pain and swelling can be relieved with some home remedies like eating high fiber food which make the bowel movement easier by softening the stools and increasing the bulk of the stools passed.

Pain killers can also provide relief.

Application of creams with hydrocortisone helps and using pads with witch hazel or any other numbing agent helps.

Soaking the anal area in warm water for 10 to 15mins every day for 2 to 3 three times will provide relief.

Doctors might suggest creams, ointments and pads containing ingredients such as witch hazel, or hydrocortisone and lidocaine. Along with the above mentioned remedies.

Drinking a lot of water will prevent hard stools and in turn facilitate easier bowel movement.

Medications such as diltiazam, nifedipine, or nitroglycerin ointment help in relaxing the anal sphincter muscles aiding recovery.

Stool softeners are also recommended in order to make passing stools easy.

Externally applied nitroglycerin promotes blood flow and this helps the anal sphincter to relax thus facilitating the fissures to heal.

Botulinum toxin type A (Botox) injection relaxes the anal sphincter when administered and helps in relaxing spasms.

How is the surgical procedure

carried out?

If the fissures are too chronic and do not respond to any non-surgical treatments then sphincterotomy is performed. The procedure is conducted under the influence of local or general anesthesia. The surgery involves cutting of small portion of anal sphincter muscle which will facilitate healing and recovery from the fissure.

The other approach is use of a laser in the surgical procedure to conduct sphincterotomy; this is done under the influence of local anesthesia. During the procedure a laser beam is used to cut a small portion of the muscle in the anal sphincter. This will help the area to heal and aid recovery from the damage caused by the fissure.

A laser surgery is a minimally invasive procedure and takes about two hours. The patient can be discharged the same day if the doctor is satisfied with his/her condition.

How long does it take to recover from the surgery and

what is the recovery process like?

The doctor will advise bed rest for 24 hours after the surgery.

During the recovery process any kind of strenuous activity like heavy lifting and jarring movements should be avoided.

There might be some cramping post the surgery which will go away in a day or two.

Nausea felt by the patient immediately after the surgery is due to the anesthesia.

The patient might also feel constipated after surgery in such a case he/she can ask doctors for remedial medicines.

After a laser surgery the doctor will advise bed rest for 3 days, the pain after the surgery is very less and the patient can cope with it using medication.

In case of bleeding, urination related issues, fever and pus formation in the incisional region it is better to get in touch with the doctor.

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