Fissure surgery or sphincterotomy is less painful than the fissure itself. This surgery causes mild pain and reduces pain and pressure resulting from fissures. Some of the complications of sphincterotomy involve:
- Temporary inability to control gas
- Mild fecal leakage
However, the fissures heal completely within eight weeks after the surgery.
What is an anal fissure?
An anal fissure is a small tear around the lining of the anal canal. Anal fissures manifest with a painful ulcer at the end of the anal canal. The anal canal is a short tube surrounded by muscles at the end of the colon (the rectum).
Anal fissures can cause severe pain and bleeding during defecation and continue for several hours after defecation. An anal fissure should not be confused with hemorrhoids because the latter occurs due to an engorged vein in the anal canal.
Anal fissures can be caused because of the following factors:
- Passing hard stools that results in tearing around the lining of the anal canal
- Increased muscle tone in the anal canal
- Decreased nitric oxide synthesis - which facilitates relaxation of the internal anal muscles
What is a sphincterotomy (fissure surgery)?
A sphincterotomy is a surgical procedure used for treating chronic anal fissures. Anal fissure management includes surgical and nonsurgical treatment. When nonsurgical methods fail to provide any relief, physicians prefer surgical methods to treat anal fissures.
Surgical methods used for treating anal fissures are as follows:
- Lateral internal sphincterotomy
- V-Y advancement flap
A lateral internal sphincterotomy is the most preferred choice for surgical treatment of anal fissures. More than 90% of patients heal after a lateral internal sphincterotomy.
When is a sphincterotomy indicated?
A sphincterotomy is indicated in the following conditions:
- Chronic anal fissures
- Fissures associated with increased muscle tone
- Fissures complicated by underlying infected fistula (tunnel between skin and anus)
- Persistent pain and bleeding
- Lack of response to medical management
How is a sphincterotomy performed?
A sphincterotomy is generally performed under local anesthesia. The surgeon performs the surgery in two ways. In an open sphincterotomy, the surgeon makes a small cut in the skin to reach the sphincter muscle. Once the sphincter muscle is visible, the surgeon cuts into it. In this method, the incision may be left open to heal. In a closed sphincterotomy, the surgeon passes a blade under the skin to access the sphincter muscle.
What to expect after a sphincterotomy?
- Pain is likely for 24-48 hours. Taking Tylenol (acetaminophen) can ease the pain in patients.
- Bleeding may be observed in patients for the first few weeks post the surgery.
- Constipation may be observed in patients for a few days; however, they should avoid straining while defecating.
- Patients should not lift anything heavy for 24-48 hours.
- Most patients can resume work and normal routine one to two weeks after the surgery.
- Patients should check out for the following symptoms:
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