Anal Fissure Treatment in Delhi

Indications

Surgery is indicated for:

• Chronic anal fissures that persist for more than 6-8 weeks despite conservative treatments (e.g., topical medications, stool softeners, dietary changes).
• Severe pain that interferes with daily activities.
• Recurring fissures.
• Complications such as a sentinel pile (skin tag) or hypertrophied anal papillae.

Types of Surgery

1. Lateral Internal Sphincterotomy (LIS)
   • Procedure: The most common and effective surgical treatment for anal fissures. A small portion of the internal anal sphincter muscle is cut to reduce muscle spasm, decrease pain, and promote healing.
   • Advantages: High success rate with most patients experiencing complete healing and significant pain relief.
   • Disadvantages: Small risk of temporary or permanent incontinence.
2. Anal Advancement Flap
   • Procedure: Used for more complex or recurrent fissures. The fissure and surrounding scar tissue are removed, and a flap of healthy tissue from the rectum is advanced to cover the area.
   • Advantages: Preserves sphincter function, reducing the risk of incontinence.
   • Disadvantages: More complex procedure with a longer recovery period.
3. Botulinum Toxin (Botox) Injection
   • Procedure: Botox is injected into the anal sphincter to temporarily paralyze the muscle, reducing spasm and allowing the fissure to heal.
   • Advantages: Minimally invasive with no surgical incision.
   • Disadvantages: Temporary effect; fissures may recur once the Botox wears off.

Procedure Steps for Lateral Internal Sphincterotomy (LIS)

1. Preoperative Preparation
   • Medical evaluation and history.
   • Instructions on fasting and bowel preparation if necessary.
   • Discussion of anesthesia options (typically local or general anesthesia).
2. Anesthesia
   • Local anesthesia with sedation or general anesthesia, depending on patient preference and surgeon’s recommendation.
3. Surgical Procedure
   • Incision: A small incision is made near the anal fissure.
   • Sphincterotomy: A small portion of the internal sphincter muscle is carefully cut.
   • Closure: The incision may be left open to heal naturally or closed with sutures.
4. Postoperative Care
   • Pain Management: Pain relief medications as prescribed.
   • Wound Care: Keeping the surgical area clean and dry. Warm sitz baths can help reduce pain and promote healing.
   • Dietary Changes: High-fiber diet and adequate fluid intake to prevent constipation and straining.
   • Activity Restrictions: Avoid heavy lifting and strenuous activities for a few weeks.
   • Follow-Up: Regular follow-up visits to monitor healing and address any complications.

Risks and Complications

• Infection: Risk of infection at the surgical site.
• Bleeding: Some bleeding is normal, but significant or persistent bleeding should be reported.
• Incontinence: Small risk of temporary or permanent incontinence, particularly with LIS.
• Recurrence: Although less common after surgery, fissures can recur.

Conclusion

Anal fissure surgery, particularly lateral internal sphincterotomy, is an effective treatment for chronic anal fissures that do not respond to conservative measures. The goal is to reduce pain, promote healing, and prevent recurrence while minimizing complications. Proper preoperative preparation, skilled surgical technique, and diligent postoperative care are essential for achieving the best outcomes and improving the patient’s quality of life.