Fissurectomy

Fissurectomy surgery

Fissureectomy is a medical operation to cure chronic anal fissure- tiny yet painful lincings cuts in the lining of the anal canal that fail to heal with medicines, alteration in diet, as well as other non-operative therapy measures.

Who Needs Fissurectomy?

The fissureectomy is typically proposed when:

• The anal fissure has persisted beyond 6 -8 weeks.
• Extreme pain during or after bowel movements.
• Anus bleeding is repeated.
• Medications, salves or Botox shots have all been unsuccessful.
• The fissure is fibrotic or scarred.

Anal fissurectomy procedure

Anal fissurectomy refers to the medical operation that is applied in treating chronic anal fissures by excising the non-healing fibrotic fissure tissue to allow the healthy tissue to heal well.

Procedure:

Preoperative Preparation

• Physical examination, proctoscopy.
• Blood tests and fitness of anaesthesia.
• Bowel preparation (normal)
• 6-8 hours preoperative fasting.

Anaesthesia

• Carried out with either spinal or general anaesthesia.
• Lithotomy or prone jackknife position of patient.

Surgical Steps

• A retractor is used to open the anal canal.
• Chronic fissure with the surrounding scar tissue is removed cautiously.
• The unhealthy fissure base will be scraped off until the healthy bleeding tissue comes out.
• The wound is left open to heal itself.
• In others, lateral internal sphincterotomy (LIS) is also included in order to minimize sphincter spasm and pain.

Completion

• Bleeding is controlled
• Stitches are not normally necessary.
• Sterile dressing applied
• Procedure time: 20–40 minutes

After the Procedure

• Observation for a few hours
• Medications on pain are administered.
• Sitz baths advised
• Stool softeners prescribed
• Last discharge day or day after that.

Recovery Timeline

• Pain improves within 7–10 days
• Wound healing takes 4–6 weeks
• The normal activity is regained in 1 -2 weeks.

Fissurectomy recovery

Once proper care, diet and bowel habits are observed, recovery following fissurectomy is normally easy. Below is a comprehensive recovery plan that does not involve technical jargon.

Early Recovery (First 24-48 Hours)

• Discomfort or burning sensation in the region is mild to moderate. 
• Some little bleeding or discharge can take place.
• Narcotics and stool softeners are initiated.
• A majority of patients leave in the same day/ next day.

First Week After Surgery

• Suffering during bowel movements slowly reduces.
• Sitz baths (warm water) 2-3 times a day and following stools are good in healing.
• Smooth stools are of importance--constipation should be prevented.
• Light walking is encouraged
• Sitting and straining should be avoided.

2–4 Weeks After Surgery

• Significant pain relief
• Wound starts healing well
• Discharge reduces
• One can resume normal everyday activities.
• Resume low-fiber diet and water.

Complete Healing Time

• The healing of wounds normally takes 6-4 weeks.
• It can take up to 8 weeks based on the severity of the fissure.

Diet During Recovery

• Fruits, vegetables and whole grains are high in fiber. 
• Adequate fluids (2.5-3 L/d) 
• Do not eat spicy food, alcohol and junk food.
• Use stool softeners / fiber supplements if recommended. 

Fissurectomy complications

Fissurectomy is mostly a safe and low risk procedure particularly when it is administered by a skilled colorectal surgeon. Nonetheless, as is the case with any surgery, there are certain complications.

Common & Mild Complications

They tend to be short-term and controllable:

• Abdominal pain (most common) with bowel movements.
• Minimal vaginal bleeding.
• Watery or mucous discharge
• Local swelling or erythema.
• Delayed wound healing

Less Common Complications

• Infection at the wound site
• Continuous pain in the fissure several weeks.
• Development of granulation tissue.
• The development of skin tags or sentinel piles.

Uncommon yet Severe Complications

• Heavy bleeding
• Non-healing or recurrent fissure.
• Anal stenosis (narrowing) - extremely rare.
• Abscess or fistula formation - exceedingly uncommon.
• Temporary gas incontinence (infrequent, particularly when combined with sphincterotomy)
• After fissurectomy is done alone, permanent fecal incontinence is extremely uncommon.

Fissurectomy pain relief

Post fissurectomy pain is natural particularly when passing the bowel in the first days, which however becomes less with proper care. The following is a simple and effective instruction on pain relief.

How Long Does Pain Last?

• First 3-5 days: mild to severe pain or burning feeling
• 1-2 weeks: The pain decreases considerably.
• 3-4 weeks: slight or no pain in the majority of the patients.

Ways to Soothe Pain after Fissurectomy

Sitz Baths (Most Important)

• Sit in warm water for 15–20 minutes
• Take this 2 to 3 times a day and following bowel movements.
• Calms the sphincter muscles and enhances blood circulation.

Pain Medications

• Painkillers such as paracetamol either prescribed or bought over the counter. 
• Self-use of powerful pain medicines should be avoided.
• Local anaesthetic ointments can be prescribed.

Stool Softening (Critical in Pain Control)

• Fiber products or stool softeners
• Consume 2.5 to 3 liters of water a day. 
• Soft stools = less pain

Diet for Pain Reduction

• Fiber foods: vegetables, clear grains, fruits.
• Avoid spicy food, alcohol, fried and junk food.
• Foods that lead to constipation are to be avoided.

Proper Bowel Habits

• Do not strain
• Go to the toilet whenever you want to. 
• Don’t sit on the toilet for too long. 

Local Care

• Keep the area clean and dry
• Gently wash after stools
• Do not use severe soaps or wiping aggressively.

Best hospital for fissurectomy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Fissurectomy is a safe, effective, and sphincter-sparing surgical procedure to treat chronic anal fissures which are not responding to medical management. Even though one should anticipate certain pain and discomfort the first few days, a combination of effective postoperative management, such as pain medications, sitz baths, high-fiber diet, and proper bowel habits will help most patients experience a gradual pain relief and full recovery. Fissurectomy offers a long time anal pain and bleeding relief with low risk of severe complications and undergoing incontinence, particularly when carried out by a skilled surgeon. Stool softness and healthy bowel habits are vital in ensuring success in the long term and avoiding the relapse.

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FAQ

Is fissurectomy a significant operation?

• No. It is a minor surgery operation, typically done in 20-40 minutes and discharged same or the following day.

Is fissurectomy painful?

• A certain measure of pain will be experienced at the onset, particularly when bowel movements take place, but with appropriate care, the pains will fade away within 7-10 days.

Does fissureectomy or sphincterotomy have greater advantage?

• Fissurectomy is used when the patient is at risk of incontinence whereas the gold standard of the chronic fissure is the lateral internal sphincterotomy. The decision is made on the basis of patient-specific factors.

Are fissures recurrent following fissurectomy?

• It can come back but is rare in case constipation, hard stools or poor bowel habits persist.

Are there any chances of incontinence following fissurectomy?

• The probability of risk is minimal, particularly when no sphincterotomy is performed with fissurectomy.

Is laser fissurectomy more effective than conventional fissurectomy?

• Laser fissurectomy could provide less bleeding and quicker comfort, but the wound healing result was similar. The surgeon’s experience is more important than the method.