A surgical procedure performed for chronic anal fissures that do not respond to conservative treatment. It reduces pain and allows the fissure to heal.
Indication
- Chronic anal fissure (anal tear lasting longer than 6 weeks)
- Fissure unresponsive to conservative treatment (topical nitroglycerin, calcium channel blocker, sitz bath)
- Recurrent acute fissure episodes
- Severe defecation pain accompanied by anal sphincter spasm
- Fissure with sentinel papilla or hypertrophic anal papilla
- Patients whose quality of life is affected by bleeding and persistent discomfort
Preparation
- Fasting for 6-8 hours before the procedure (according to the type of anesthesia)
- Blood thinners are stopped with physician approval if used
- Preoperative blood tests and ECG (according to age and risk profile)
- A bowel-cleansing enema may be administered on the morning of surgery
- Cleansing and, if needed, shaving of the anal area
How it's performed
- The patient's vital signs (blood pressure, pulse, oxygen) are continuously monitored
- General, spinal, or local anesthesia is administered by the anesthesiologist
- The patient is placed in the lithotomy position and the anal area is sterilized
- Using lateral internal sphincterotomy, a portion of the internal sphincter muscle is relaxed in a controlled manner
- Sentinel papilla and hypertrophic anal papilla, if present, are removed
- Hemostasis is ensured and a small open area is left that does not require sutures
Post-procedure
- Discharge after same-day or 1-day hospital observation
- Topical anesthetic creams and pain relievers for the first 2-3 days
- Warm sitz baths 2-3 times a day (10-15 minutes)
- A high-fiber diet and adequate fluid intake; fiber supplements to prevent constipation
- Follow-up examinations at week 1 and week 4
Risks
- Temporary loss of gas or stool control (usually resolves in the first weeks)
- Bleeding or hematoma
- Surgical site infection (rare)
- Recurrence of the fissure (rare)
- Fistula formation (very rare)
FAQ
When can I have a bowel movement after the procedure?
Having a bowel movement on the first day after the procedure is normal. A high-fiber diet, and stool softeners if recommended by your physician, can be used to keep stools soft.
When can I return to work?
For office work, return is generally possible after 3-7 days; for jobs requiring physical work, after 10-14 days. Recovery may vary individually.
Can the fissure recur?
The recurrence rate after surgery is low. A high-fiber diet, adequate fluid intake, and avoiding constipation help prevent recurrence.
What is the risk of fecal incontinence?
Temporary mild gas leakage may occur in the first weeks and resolves spontaneously in most patients. Permanent loss of control is a rare complication.
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