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Fissure repair

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Do you mean anal fissure repair? If so, are you asking about the procedure, recovery, or treatment options?

What does anal fissure repair involve?

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"Anal Fissure"[MeSH Terms] AND surgery

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ASCRS clinical practice guideline anal fissure treatment lateral internal sphincterotomy advancement flap

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“Anal fissure repair” usually means treatment for a chronic anal fissure, a painful tear in the lining of the anal canal that has not healed with stool-softening measures and prescription ointments.

What the operation commonly involves

  1. Lateral internal sphincterotomy (LIS)
    • This is the usual definitive operation for many chronic fissures.
    • Under anesthesia, the surgeon makes a small incision beside the anus and divides a small, controlled part of the internal anal sphincter muscle.
    • The goal is to reduce muscle spasm and improve blood flow, so the fissure can heal naturally. The fissure itself is generally not simply stitched closed.
    • It is commonly an outpatient, same-day procedure. The surgical-text reference describes LIS as the standard surgical treatment, with reported healing rates around 92%-95%. ASCRS patient guidance describes the same goal: relaxing the sphincter to reduce pain and permit healing.
  2. Botulinum toxin injection
    • Botox may be injected into the internal sphincter to temporarily relax it.
    • It is less invasive and can be suitable for some people, but the fissure can recur and repeat treatment may be needed. ASCRS guidance reports healing in roughly 50%-80% of patients.
  3. Fissurectomy with an anal advancement flap
    • The surgeon removes scarred fissure tissue, then mobilizes a small piece of nearby healthy skin/tissue and sutures it over the defect.
    • This preserves the sphincter muscle and is more often considered if dividing the sphincter could raise the risk of bowel-control problems, such as with prior obstetric sphincter injury, existing leakage, low resting sphincter pressure, or certain bowel diseases.
    • The flap is advanced without tension and secured with absorbable stitches. Bailey and Love's Short Practice of Surgery, 28th ed., anal fissure section. The 2023 ASCRS guideline supports anocutaneous advancement flaps as a sphincter-preserving option for higher-risk patients.

Recovery

  • Pain often improves over days to a few weeks, while complete fissure healing may take several weeks.
  • Usual aftercare includes stool softeners or fiber, good fluid intake, warm sitz baths, avoiding straining, and prescribed pain relief.
  • Follow the surgeon’s instructions on activity, wound care, and when to return to work.

Risks

Possible complications include bleeding, infection, delayed healing, recurrence, and rarely abscess or fistula. The main specific concern with sphincterotomy is a change in continence, such as difficulty holding gas, minor staining/soiling, and uncommonly stool leakage. This is why the surgeon considers your prior childbirth injuries, bowel habits, existing continence, and sphincter function before choosing the procedure.
Seek urgent surgical advice for fever, worsening swelling or pain, heavy bleeding, pus, or inability to pass urine or stool after surgery.

Available fissure pathogenesis, paitent has a history of constipation since 4 years on and off and painful defecation since 2 months

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