Chronic Fissure surgeries

If a fissure persists even after treatment, it may become a chronic problem. A chronic fissure may need to be treated with surgery. Two different types of surgery are done for fissures -- anal dilation and lateral internal sphincterotomy (LIS).

Anal dilation may be a choice for some patients, but it is being used less often due to the potential of incontinence as a complication. During anal dilatation, the anal canal is stretched.

More often, the LIS surgery is used. LIS is usually done with a general anesthetic on an outpatient basis. In the procedure, a portion of the anal canal muscle is cut. The fissure itself is not removed, but any muscle spasms in the anus sphincter will be relieved. This will allow the fissure to heal at a cure rate of more than 90%.

After surgery, it is important to keep the anal area clean and dry. Moist wipes instead of toilet paper and a stool bulking agent may be recommended.

Sphincterotomy

Lateral internal sphincterotomy involves stretching or cutting the internal sphincter, the muscle that restricts and relaxes when stool passes from the body. Cutting the muscle prevents spasm and temporarily weakens the muscles, and this in turn helps the area to heal. The surgeon removes the fissure and any underlying scar tissue.

The surgery can be performed under local anesthesia, which involves injecting the immediate area with a numbing agent similar to that used at the dentist's office, or spinal anesthesia, which numbs the entire lower body. In some cases, general anesthesia may be used, which renders the patient unconscious. The choice of anesthesia depends on patient and physician preference, the patient's health, and the standard practice of the particular facility.

The patient is positioned on the table so that the anus and rectal area are exposed. This can be done face down, with the buttocks slightly elevated, or supine (on the back) with the legs held up in stirrups. After anesthesia is administered, the area is cleaned with an antiseptic solution.

The operation takes about 20 to 30 minutes. The wound is then sutured closed, usually with stitches that dissolve in time. Most patients can go home the same day.