Fissurectomy Surgery: Procedure, Benefits & More

Overview

Fissurectomy is one of the several techniques used to treat chronic (long-standing) anal fissures that involves cutting off the fissure and the skin around the fissure. It is an effective way of treating fissures with a very low chance of recurrence. Anal fissures are tears that occur in the lining of the anal canal. Fissures are generally associated with constipation and cause severe pain during and after a bowel movement. 

Small fissures usually resolve on their own or with medical treatment. Long-standing chronic fissures lead to the development of a skin fold over the tear, either inside or outside the anal opening. If a fissure is present for more than 8 weeks, it is called a chronic fissure and needs surgical intervention. 

Fissures can get complicated when there is the development of an abscess. Your surgeon will suggest several surgical techniques to remove the anal fissure, including a fissurectomy. Let us learn more about how fissurectomy is performed, its benefits, complications, and the outlook after the procedure.

What Is Fissurectomy?

A fissurectomy is a surgical way of treating an anal fissure. A fissure in your anus can be an uncomfortable thing to live with. It causes severe pain and burning before and after stools. Your surgeon will try to treat you with medications initially. When medications fail, if the pain is intense, or if the fissure has become infected, you will be given the option of surgery. Fissurectomy surgically removes the fissure and the skin alongside it. This helps you get rid of the symptoms so you can live a quality life.The procedure is done under general or local anesthesia. You can go home the same day once your vitals have stabilized and there are no complications after the procedure.

When Is A Fissurectomy Recommended?

Fissurectomy is a surgical procedure that aims to reduce your symptoms due to fissures. You will be recommended a fissurectomy in the following conditions:

• Failure to respond to medical treatment
• Severe pain, burning, and bleeding in spite of taking treatment
• Chronic, long-standing fissures
• Development of infections
• Development of skin tags (non-cancerous growth on the skin that develops when the skin rubs against itself) and sentinel piles (a tag os skin that develops at the edge of the anus)

How To Prepare For Fissurectomy?

A fissurectomy procedure involves removing the fissure along with the skin. The aim of a fissurectomy is to get rid of your symptoms. Here is how you can prepare for this procedure.

Before The Procedure:

• Your surgeon will get a detailed personal and medical history from you and perform a rectal examination to understand the location of the fissure 
• Your surgeon will suggest tests like:
  • Anoscopy- This test involves inserting a tubular device fitted with a camera that helps to view your anus and rectum
  • Flexible sigmoidoscopy- In this procedure, a tube known as a sigmoidoscope is inserted into your anus to help the surgeon visualize the anus and rectum. This procedure is recommended if you are under 45 years and have no risk factors for developing colon cancer and intestinal diseases.
  • Colonoscopy- This procedure is similar to sigmoidoscopy and is done in people over 45 years of age or at risk of developing colon cancer.
  • Routine tests like a complete blood count, X-ray, ECG (electrocardiogram), and urine examination.
  • Computed Tomography (CT scans) or Magnetic Resonance Imaging ( MRI)- These imaging tests may be suggested by your surgeon..
• You will be asked to sign an informed consent form agreeing to proceed with the surgery.
• You should inform your surgeon about:
  • Medications that you are currently taking for your health conditions
  • Any dietary supplements and herbs that you are taking
  • Allergies towards any medicines.
• You will be asked to stop medications like blood thinners (to prevent excessive bleeding during and after surgery) a week before surgery.
• On the day of the surgery, you will be asked to fast for at least 12 hours before the surgery.
• Since you can go home the same day as the surgery, you should arrange for a friend or a relative to drive you home after the surgery is completed.

What Happens During Fissurectomy?

A fissurectomy surgery is recommended to you when your symptoms have become severe, or you have stopped responding to medical treatment. It is also recommended in case of the development of complications like an anal abscess. This procedure is done under general or spinal anesthesia and takes about 15 to 30 minutes.. Depending on your health status post the procedure, you may be sent home the same day or may have to stay in the hospital for a couple of days.

During The Procedure:

• An IV line will be set up to administer fluids into your body.
• You will be given an enema to help empty your bowels.This helps the surgeon for better visualization of the site to be operated.
• General or spinal anesthesia will be administered.In general anesthesia, you will be asleep throughout the procedure; in spinal anesthesia, the area to be operated on will become numb. Normally, sedatives are given with spinal anesthesia to put you under light sleep during the procedure.
• You will be made to lie on the table on one side, prone-jackknife, or in a lithotomy position. The surgeon will decide on the surgery position for ease of operation. 
• An electric scalpel is used for the procedure. Your surgeon will make an incision around the fissure's edge and then move up the dentate line (the line that divides the anal canal into upper 2/3rd and lower 1/3rd) to reach the fissure. In this procedure, the sphincter muscles are not cut.
• Once the fissure is located, it will be cut and removed from its place. This is called surgical excision. Your surgeon will remove the adjacent skin folds and tags along with the fissure. 
• Once the excision is complete, an anoplasty is performed. This is a surgical procedure to repair and reconstruct your anus. Here the surgeon will partially cover the wound with a small piece of the mucosa (the inner lining) taken from the rectum.

The procedure takes about fifteen to thirty minutes to complete. It will take about ten weeks to heal and completely recover from a fissurectomy surgery.

What To Expect After Fissurectomy?

A fissurectomy surgery takes fifteen to thirty minutes to complete. It assures you freedom from the symptoms of fissures. Here is what you can expect after the surgery.

After The Procedure:

• After the procedure,, you will be wheeled into the recovery room. Your vitals, like your pulse rate, respiratory rate, temperature, and blood pressure, will be monitored.
• You will be allowed to go home when your vitals are stable, and the effects of the anesthesia have worn off.
• You will feel pain and discomfort in your anal area for several days after the surgery.
• Your surgeon will prescribe medications to control the pain and prevent antibiotics.
• You will be given a fiber supplement and a laxative to help soften your stools and allow free motion.
• Detailed instructions on wound care will be given, and the symptoms to look out for will be explained to you before you go home.

Healing from the surgery may take ten weeks. Once the pain and swelling are controlled, you may slowly return to your routine. Remember to take things slow till you have healed completely.

Simple Aftercare Tips That Help In Wound Healing

1. It is advisable to avoid strenuous activities for a couple of weeks after surgery. Take adequate rest. You may be able to get back to work the next day, but you will end up feeling exhausted very quickly. Hence it is advisable to take things slow.
2. Avoid using tissues after bowel movements. Instead, use mild soap and water and pat dry the area well. Any moisture left behind may become a breeding site for germs.
3. You may find fresh blood in your stools for a few days after surgery. This is expected. Apply gentle pressure on the anus with a soft cloth and lie flat on your bed. This helps to stop the bleeding. However, if the bleeding is persistent or if you find clots in your blood, call your surgeon immediately.
4. Take frequent Sitz baths. This is a technique that helps to reduce the pain and swelling in the anal area. You must sit in a shallow tub or basin filled with warm water for fifteen to twenty minutes. You may add a betadine solution for extra protection. A Sitz bath is beneficial for the following reasons-
   1. Reduction in swelling
   2. Pain relief
   3. Improvement in blood flow to the anal region, ensuring better healing.
5. Eat bland food. Avoid spicy, oily, and salty food. Include a lot of fibrous food in your diet as they help prevent constipation and ensure easiness in passing stools.
6. You should keep yourself hydrated by drinking 2 to 3 liters of water daily.

What Are The Benefits & Risks Of Fissurectomy

Fissures can be managed with medications alone. Surgery is only recommended when the fissure is not healing even after long-term treatment and has become infected and developed other complications. Fissurectomy, even though considered very safe and effective, does come with some risks. Let us look at the benefits and risks of a fissurectomy surgery:

Benefits: 

• High success rate (>95%)
• Rapid recovery from symptoms
• No risk of fecal incontinence (passing stools involuntarily)

Risks:

• Delayed healing of the wounds, as compared to other methods of treating fissures
• Possibility of excessive blood loss during surgery
• Pain and discomfort in the anal area leading to difficulty is sitting, sleeping and passing stools
• Constipation
• Bleeding from the rectum

Why Choose Medfin?

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!