46940 Curettage or cautery of anal fissure, including dilation of anal sphincter (separate procedure); initial

Name of the Procedure:

Curettage or Cautery of Anal Fissure, including Dilation of Anal Sphincter (separate procedure); initial.

Summary

This procedure involves the removal (curettage) or burning (cautery) of an anal fissure—a small tear in the lining of the anus—combined with the stretching (dilation) of the anal sphincter to alleviate pain and promote healing.

Purpose

Medical Condition Addressed:

• Chronic anal fissure

Goals/Outcomes:

• To alleviate pain
• Promote healing of the fissure
• Reduce spasm and tightness in the anal sphincter

Indications

Symptoms/Conditions:

• Persistent anal pain
• Bleeding with bowel movements
• Chronic fissures that haven’t responded to conservative treatments

Patient Criteria:

• Patients with chronic or recurring anal fissures
• Patients who have not found relief through medications or other non-surgical treatments

Preparation

Pre-Procedure Instructions:

• Fasting for 6-8 hours before the procedure
• Adjustment of medications as advised by the healthcare provider (e.g., stopping blood thinners)
• Laxative or enema may be recommended for bowel preparation

Diagnostic Tests:

• Physical examination
• Possibly an anoscopy or sigmoidoscopy to visualize the fissure

Procedure Description

Steps Involved:

1. Patient is placed in a suitable position (e.g., lithotomy or prone position).
2. Administration of anesthesia (general or regional) to ensure comfort.
3. The surgeon uses specialized tools to perform curettage or cautery to remove or burn the fissure tissue.
4. Anal sphincter is gently dilated to reduce muscle spasm and decrease pressure in the area.
5. Any bleeding is controlled, and the area is cleaned.

Tools and Equipment:

• Curette or cautery device
• Dilation instruments

Anesthesia:

• General anesthesia or regional anesthesia (spinal or epidural)

Duration

• Typically, the procedure takes about 30 to 60 minutes.

Setting

• Performed in a hospital or surgical center, often on an outpatient basis.

Personnel

• Surgeon
• Anesthesiologist
• Nursing staff and surgical technicians

Risks and Complications

Common Risks:

• Pain or discomfort post-procedure
• Bleeding

Rare Complications:

• Infection
• Anal stenosis (narrowing of the anal canal)
• Incontinence (rare)

Management:

• Pain management with prescribed medications
• Antibiotics for infection (if needed)
• Follow-up care for any complications

Benefits

• Relief from chronic pain
• Improved healing of the fissure
• Generally, benefits can be realized within a few weeks

Recovery

Post-Procedure Care:

• Pain management with medications
• Sitz baths to soothe the area
• High-fiber diet and stool softeners to avoid straining

Recovery Time:

• Most patients can return to normal activities within a week
• Full recovery may take a few weeks

Restrictions/Follow-Up:

• Avoid heavy lifting or strenuous activities for a few days
• Follow-up appointments to monitor healing

Alternatives

Other Treatment Options:

• Topical anesthetics and nitroglycerin ointment
• Botulinum toxin (Botox) injections
• Conservative treatments like diet modifications

Pros and Cons:

• Non-surgical options are less invasive but may not be effective for all patients
• Surgery offers more definitive relief but carries surgical risks

Patient Experience

During Procedure:

• Patients will be under anesthesia, so they should not feel pain during the procedure.

After Procedure:

• Some discomfort and bleeding can be expected
• Pain management with prescribed painkillers
• Instructions for home care to facilitate recovery

Pain will be managed through the prescribed medication, and comfort measures like sitz baths can aid in reducing discomfort.