Fissure in Ano with Internal sphincterotomy with fissurectomy

1. Fissure in Ano with Internal sphincterotomy with fissurectomy

2. Index • Introduction • Symptoms • Causes • Treatment • Recovery • About Meddco

3. Introduction An anal fissure is defined as a longitudinal split in the distal anoderm which extends from the anal verge to the dentate line. Fissures can be of primary or secondary type. The posterior midline is the most common location for primary fissures, while, anterior primary fissures, though rare, are more common in females. The cause of primary fissure is idiopathic. But secondary fissures are associated with other systemic diseases and can occur at an abnormal position anywhere in the anoderm. A high percentage of acute fissures heal spontaneously within three weeks with conservative medical management comprising of a high fiber diet, warm sitz bath, and topical analgesic with steroids. Secondary anal fissures will not heal in any form of treatment until the primary cause is addressed. These fissures often need surgical treatment. The lateral internal sphincterotomy (LIS) is one of the most practiced treatments for chronic anal fissure. Nonetheless, anal incontinence is one of the worrisome complications of LIS. Fissurectomy is one of the options among those techniques which address the issues with LIS. Some studies showed that patients with chronic fissures who are refractory to medical treatment responded well to fissurectomy. Hence, this study was conducted to compare the outcomes of fissurectomy and lateral internal sphincterotomy in the treatment of chronic anal fissure and compare recurrence and postoperative complications among both the procedures.

4. Symptoms Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as increased fiber intake or sitz baths. Some people with anal fissures may need medication or, occasionally, surgery. The clinical hallmark of an anal fissure is pain during, and particularly after, defecation. In acute fissures, pain may be short-lived, but it can last several hours or even all day in the presence of a chronic fissure. The pain is frequently described as passing razor blades or glass shards. Understandably, patients with anal fissures may often fear bowel movements. Rectal bleeding, although not uncommon, is usually limited to minimal bright red blood seen on the toilet tissue.

5. Causes Common causes of anal fissure include: • Passing large or hard stools • Constipation and straining during bowel movements • Chronic diarrhea • Anal intercourse • Childbirth Less common causes of anal fissures include: • Crohn's disease or another inflammatory bowel disease • Anal cancer • HIV • Tuberculosis • Syphilis

6. Treatment If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing.

7. Recovery • Get plenty of rest. • Try to walk a little each day. • Follow your doctor’s instructions as to when you can drive again. • Shower or bathe as normal, but pat your anal area dry afterward. • Drink plenty of fluids. • Eat a high-fiber diet. • If you are struggling with constipation, ask your doctor about taking a mild laxative or stool softener. • Take your pain medications exactly as described.

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