Name of the Procedure:

Fissurectomy, including sphincterotomy when performed.

Summary

A fissurectomy is a surgical procedure performed to treat an anal fissure, which is a small tear in the lining of the anus. This procedure may also include a sphincterotomy, where a small cut is made in the anal sphincter muscle to reduce spasm and pain, facilitating easier healing.

Purpose

The procedure is aimed at resolving chronic anal fissures that do not respond to other treatments. The goals include relieving pain, promoting healing of the fissure, and reducing the frequency of fissure recurrence.

Indications

• Chronic anal fissure not responding to medical treatments
• Significant pain and discomfort, particularly during bowel movements
• Bleeding associated with the fissure
• Recurring fissures
• Associated muscle spasm detected during examination

Preparation

• Patients may be advised to fast for several hours before the procedure.
• Medications that increase bleeding risk, such as blood thinners, may need to be adjusted.
• A bowel preparation, such as a laxative or enema, may be required.
• Preoperative assessment including a thorough history and physical examination.

Procedure Description

1. The patient is positioned appropriately, usually on their side or in a lithotomy position.
2. General or regional anesthesia is administered to ensure the patient is comfortable and pain-free.
3. The surgeon makes an incision to remove the fissure and any associated scar tissue.
4. If a sphincterotomy is performed, a small incision is made in the internal anal sphincter to reduce muscle spasm.
5. The area is carefully irrigated and checked for any remaining signs of the fissure.
6. The incision may be left open or closed with sutures, depending on the specific circumstances and surgeon's preference.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

Fissurectomy is usually performed in a hospital or surgical center, often on an outpatient basis.

Personnel

• General or colorectal surgeon
• Anesthesiologist
• Surgical nurses and support staff

Risks and Complications

• Infection
• Bleeding
• Incontinence (rare)
• Pain at the site of surgery
• Delayed healing
• Recurrence of fissure
• Adverse reaction to anesthesia

Benefits

• Relief from chronic pain
• Promotion of fissure healing
• Reduction in the recurrence of fissures
• Improvement in quality of life

Recovery

• Patients may experience discomfort or pain manageable with prescribed medications.
• Instructions include maintaining good hygiene, soaking in warm baths, and using stool softeners to ease bowel movements.
• Most patients can return to normal activities within a few days but should avoid strenuous activities until fully healed.
• Follow-up appointments may be necessary to assess healing and symptom resolution.

Alternatives

• Conservative treatments such as topical nitroglycerin or calcium channel blockers
• Botulinum toxin (Botox) injections into the anal sphincter
• Increased dietary fiber and water intake to ease bowel movements
• Less invasive surgical procedures, if available

Patient Experience

During the procedure, patients will be under anesthesia and should not feel pain. Afterward, patients may experience some discomfort, which can be managed with pain medications. Warm baths can help soothe the area, and patients are advised to follow a high-fiber diet to ensure smooth bowel movements and avoid strain. Regular follow-up visits help ensure proper healing and address any concerns.