Surgery in Anal Fissure Disease

Surgical Treatment of Anal Fissure Disease

In the surgical treatment of anal fissure, according to the literature results, a single operation has been decided in evidence-based modern surgery. The operation, called lateral internal sphincteratomy, provides a rapid symptomatic and objective recovery in anal fissure disease by cutting the internal muscle groups, reducing the resting pressure around the anus and increasing blood flow.

In this sense, the rapid response to anal fissure treatment after the LIS operation is superior to Botox injection, which may have a slower course. In LIS surgery, which is considered the gold standard in the treatment of anal fissure, it has been a matter of long-standing debate on which location the muscle groups will be cut, but later on, a common consensus decision was made to perform the procedure from the lateral, i.e. outer, part of the anus, where blood supply and therefore wound healing are best. Apart from this issue, which is still discussed by the authorities, another issue that is still discussed by the authorities today is how much muscle group will be cut. Two different anatomical localizations have been described in two different views. As a result of these discussions, our clinic's opinion is that the ideal sphincterotomy can be performed with a gradual incision and appropriate pressure and calibration measurements to ensure the normal pressure or calibration targeted for each patient.

In the operation defined as spasm-controlled sphincterotomy, a gradual sphincterotomy strategy should be applied until each patient's anal calibration (the limit of advancing a blunt cylinder into the anal canal without difficulty) reaches the diameter of 29-30 mm in normal adults. With this controlled strategy, according to literature information; The rates of both recurrence and deterioration in anal continence (ability to hold gas and stool) have been reduced. The surgery in which this controlled cut is made by taking pressure measurements is called pressure-controlled sphincterotomy.

The success rate of LIS surgery, which is the gold standard in the treatment of anal fissure disease, is 94-100%. The physician must inform the patient in detail about complications of the surgery, such as bleeding, hematoma (blood accumulation), abscess, and fistula, which occur in 7% of cases. (It is important to know that these figures belong to physicians experienced enough to publish case series, and that these rates are significantly higher since they are performed in random centers. The most important and serious complication of LIS is incontinence. Although it is minimal and temporary most of the time, this rate is 45%. According to research, it can be up to 1.2% and may affect the patient's quality of life.

As a result of all this evidence-based scientific data, it is extremely important that these operations be performed in the operating room environment (we do not recommend that they be performed in the office environment) by physicians who are familiar with the diseases of this region and are experienced.

If the patient is at the center on the morning of the surgery and the pain is controlled in a controlled manner, the patient will be taken into operation after an anal enema. There is absolutely no need for the patient to receive general anesthesia for this operation. It is an operation with a planned surgery duration of approximately 2 minutes, with superficial sedation performed by an anesthesiologist and local anesthesia support from the surgeon. Bleeding control is extremely important here. There is no harm in discharging the patient after a few hours of follow-up. He will be called for a follow-up examination the next day.

In the postoperative period, postoperative recommendations for all perianal region diseases and an appropriate diet program, which is extremely important in preventing the disease, will be given. Correct toilet habits of patients is an issue that should be emphasized. The patient will be advised to take water baths in the anal area with a hot shower head after defecation in the morning without straining.