Operation

• A chronic anal fissure that does not respond to conservative treatment.
• Acute anal fissure that is extremely painful and unresponsive to analgesics and conservative therapy.

A chronic fissure is a non-healing wound in the anal canal, present for weeks or months.

When performing a fissurectomy, the wound edges and the base of the wound are excised. The aim is to stimulate wound healing from the bottom up starting from a healthy wound base.
During a lateral sphincterotomy, the muscle of the internal sphincter muscle is incised to reduce the tension in the anal canal which will increase the blood supply and improve the healing of the anal fissure.

The anal sphincterotomy will decrease the spasm and the pain.

After surgery, the pain when expelling bowel movements (exoneration) will disappear after just a few days.

After surgery, the patient experiences pain similar to a bruising for an average of 2 to 6 days,

The pain is different from the tearing and stabbing pain experienced with the anal fissure.

Healing of anal fissure takes an average of 4-5 weeks. The sutures of the wound are resorbable and can be palpated at the edge of the anus for the first few weeks.

• The fissure heals in 94 to 98% of cases.
• The operation is performed in day hospital.

Infection / abscess

• Incidence : < 1%

Hematoma

• Incidence : < 1% Hemorrhage

Bleeding

• Incidence : < 1% Recurrence

Recurrence

• Incidence : < 5%

Incontinence for flatus
(usually temporary)

• Incidence : 2-8%

Normal symptoms

• Anal pain is normal but should subside over time.
• Seepage of serous (yellowish) anal fluid.
• Fluid loss may be bloody but should subside over time.

Abnormal symptoms

Contact your surgeon or GP, or go to the emergency room:

• If pain increases over time.
• If fever does not subside over time.
• If pus volume increases or foul smelling viscous fluid increases.
• If blood loss persists.

If certain symptoms seem abnormal to you contact your doctor.

If this is not possible, you can contact avec your surgeon.

If you are unable to contact your GP or your surgeon, go to the emergency department at St Elizabeth Hospital in Uccle.

Anal incontinence

• Incontinence for flatus is rare and temporary in most cases: 2-8%.
• Incontinence for liquid stools after lateral sphincterotomy is rare.

This procedure should not be performed in patients with a weak anal sphincter tonus or in female patients with a history traumatic deliveries. For these patients, other procedures should be preferred, such as Botox infiltration or a rectal mucosal or perianal skin flap.

Cochrane library ; Review. Operative procedures in fissura in ano ; Nov 2011
Richard Nelson British medical journal Clinical Evidence 2014;11:407
Hanalel et al Dis colon Rectum 1997; 40 (2):229-23
Jeniffer Sam et Al: Clin Colon Rectal Sur 2016;29: 30-37
Al -thoubaity Annals of Med and Surg 57(2020) 291-294
Turan et al Asian Journal of Surgery  (2019) 42, 628 -633
Mohammed  Alawady Int J Colorectal Dis 2018 Oct; 33 (10):1461-1467