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Medical Video: Anal Fissure Surgery Technique: Lateral Internal Sphincterotomy
Definition
What is anal fissure surgery?
The anal fissure is a tear or splitting of the anal lining (anal mucosa). Symptoms and signs that appear include pain when defecating and the discharge of bright red blood from the anus. This problem is common in children starting from one year, and affects around eight out of 10 babies. A person's vulnerability to anal fissure tends to decrease with age. Common causes in adults include constipation and trauma to the anus (such as a difficult labor).
When do I need to have anal fissure surgery?
About half of the cases that occur can heal on their own with proper treatment and avoid constipation. However, healing can be a problem if the pressure during bowel movements continues to reopen the wound. Treatment options include surgery.
Prevention & warning
What should I know before undergoing anal fissure surgery?
Surgery usually involves cutting a small portion of the anal sphincter muscle to reduce spasms and pain and speed healing. Surgery has a small risk of causing incontinence.
Are there alternatives to surgery?
There are simple treatments that can help such as laxatives, ointments, bontulinum toxin injections, increase the amount of fiber in your diet, and drink plenty of fluids.
Process
What should I do before anal fissure surgery?
An operation also called a lateral sphincterotomy can be performed under local anesthesia. An anesthetist or your doctor will explain how to prepare for your procedure. It is very important to inform your doctor if you are taking medicines, especially a type of drug called a blood thinning agent. You are also asked not to eat or drink, usually for about six hours beforehand. It is very important to follow the advice of an anesthetist, surgeon, and your doctor. You may not drink alcohol 24 hours before you are given a local anesthetic or sedative.
What is the process of anal fissure surgery?
There are several surgical techniques for treating anal fissures.
Lateral internal sphincterotomy
This procedure has the best cure rate and is the most widely used procedure for anal fissures. In this operation, your surgeon will make a small wound in the anal sphincter's internal muscle with a long incision.
Fissurectomy
In this procedure your anal fissure is fully removed, leaving open wounds to heal naturally. This operation can be applied as a single action, or with lateral sphincterotomy, or with drugs such as glyceryl trinitrate or injections of botulinum A toxin. You may have to undergo a fissurectomy if you have an anal fistula (a tunnel-like structure between the skin around the anus and rectum) and an anal fissure.
Advancement flaps
This is a technique that involves replacing damaged tissue with healthy tissue. This type of surgery is more complex and is usually only recommended if other surgical options have failed.
What should I do after anal fissure surgery?
You will need to rest until the effects of anesthesia are finished and you may need some painkillers to help relieve discomfort. You will usually be able to go home whenever you feel ready but sometimes you may need to stay in the hospital last night. If you need pain relief, you should not take drugs that contain codeine because they can cause constipation. If you have questions, ask your pharmacist for advice. You will need to open the wound cover before defecating. Be careful in washing and drying the scar area afterwards. It can take several months for full recovery from anal fissure surgery, but this varies between individuals, so it's important to follow your surgeon's advice.
If you have questions relating to the process of this test, consult your doctor for a better understanding.
Complications
What complications can occur?
Complications are when problems occur during or after surgery. Most people do not experience this complication, but complications of anal fissure surgery include: infection - this can usually be treated with antibiotics, but sometimes can develop into an anal abscess and need further surgery for anal fistula - this can be treated by surgically damaging the anal sphincter muscle - this can affect bowel control and can cause recurrent fissure incontinence - fissure may be able to return after surgery
If you have questions about possible complications, please consult your doctor for more information.
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