Anal Fissurectomy
What is Anal Fissurectomy ?
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Why do you need Anal Fissurectomy ?
Anal fissures are often caused by trauma from hard stools, chronic constipation, or prolonged diarrhea, leading to severe pain during and after bowel movements. While acute fissures may heal with conservative measures (e.g., fiber, sitz baths), chronic fissures—persisting beyond 6–8 weeks or associated with complications—require surgery. Anal fissurectomy is indicated for:
- Chronic anal fissures: Non-healing fissures with scar tissue or sentinel tags.
- Severe pain or bleeding: Impacting quality of life.
- Associated complications: Anal stenosis, fistula, or hypertrophied anal papillae.
- Failure of non-surgical treatments: Including topical medications (e.g., nitroglycerin, calcium channel blockers) or Botox injections.
Why Do Costs Vary in Philippines?
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Anal Fissurectomy Procedure
The procedure is straightforward and typically performed as a day-care or short-stay surgery:
- Before Procedure Evaluation:
- Diagnosis is confirmed via physical examination, including digital rectal exam or anoscopy, to assess the fissure’s location, depth, and associated features (e.g., sentinel tag, fibrosis).
- Blood tests and ECG may be conducted for surgical fitness, especially in older patients or those with comorbidities.
- Patients are advised to use laxatives or enemas for bowel preparation to ensure a clean surgical field.
- Discussion with the surgeon addresses pain management and post-operative care.
- Surgical Technique:
- Open Fissurectomy:
- Performed under general, spinal, or local anesthesia with sedation, lasting 15–30 minutes.
- The patient is positioned in the lithotomy (legs raised) or prone position.
- The surgeon excises the fissure, including scar tissue, sentinel tags, or hypertrophied papillae, creating a clean wound to promote healing.
- The wound is left open or partially closed to heal by secondary intention, reducing infection risk.
- Combined with Lateral Internal Sphincterotomy (LIS):
- Often performed concurrently to reduce anal sphincter pressure, which contributes to fissure persistence.
- A small incision divides part of the internal anal sphincter muscle, improving blood flow and healing.
- LIS is highly effective, with healing rates of 95–98%, but carries a small risk of incontinence.
- Minimally Invasive Techniques:
- Rarely, laser-assisted fissurectomy is used in select centers for precise tissue removal, though it’s costlier and less common.
- The procedure is typically outpatient, with same-day discharge unless complications arise.
- Open Fissurectomy:
- After Procedure:
- Patients are monitored for a few hours post-surgery to ensure stable recovery from anesthesia and pain control.
- Pain medications (e.g., paracetamol, ibuprofen) and stool softeners (e.g., lactulose) are prescribed to ease bowel movements.
- Sitz baths (warm water soaks) are recommended 2–3 times daily to promote healing and reduce discomfort.
- Follow-up visits assess wound healing and symptom relief.
Recovery After Anal Fissurectomy
Recovery is relatively quick but requires careful adherence to post-operative care:
- Hospital Stay:
- Most patients are discharged the same day (outpatient) or within 24 hours.
- Rarely, a 1–2 day stay is needed for pain management or complications.
- Post-Procedure Care:
- Pain is significant for the first 1–2 weeks, managed with oral painkillers and sitz baths.
- Stool softeners and high-fiber diets prevent constipation and reduce strain during bowel movements.
- Patients are advised to keep the anal area clean and dry to prevent infection.
- Topical creams (e.g., lignocaine) may be prescribed for local pain relief.
- Activity and Diet:
- Light activities (e.g., walking) resume within 1–2 days; strenuous activities (e.g., heavy lifting, sports) are avoided for 2–4 weeks.
- A high-fiber diet (fruits, vegetables, whole grains) and adequate hydration (2–3 liters daily) promote soft stools.
- Avoid spicy foods, alcohol, or caffeine, which may irritate the bowels.
- Follow-Up:
- Follow-up visits at 1–2 weeks and 4–6 weeks assess wound healing and symptom resolution.
- Most fissures heal within 4–8 weeks, with pain subsiding significantly by 2–3 weeks.
- Long-term follow-ups are rare unless complications (e.g., incontinence, recurrence) occur.
Most patients resume normal activities within 1–3 weeks, with 95–98% achieving complete healing when combined with sphincterotomy. Quality of life improves significantly, with minimal recurrence if lifestyle changes are maintained.
Risks and Complications
Anal fissurectomy is a low-risk procedure but carries potential complications:
- Surgical Risks:
- Bleeding or infection at the surgical site, requiring antibiotics or drainage.
- Painful wound healing, particularly if hygiene is poor.
- Sphincterotomy-Related Risks:
- Fecal incontinence (gas or minor leakage) in 1–5% of patients, usually temporary but rarely permanent.
- Incomplete sphincter relaxation, leading to fissure recurrence (2–5%).
- General Risks:
- Adverse reactions to anesthesia.
- Delayed healing in patients with comorbidities (e.g., diabetes, Crohn’s disease).
- Long-Term Issues:
- Anal stenosis (narrowing), requiring dilatation or further surgery.
- Rarely, fistula formation or chronic pain.
Prompt reporting of symptoms like excessive bleeding, fever, or incontinence ensures timely management.
Frequently Asked Questions (FAQs)
What causes chronic anal fissures?
Chronic fissures result from repeated trauma (e.g., constipation, hard stools), poor blood flow, or high anal sphincter pressure.
Can anal fissures heal without surgery?
Acute fissures often heal with fiber, sitz baths, or medications, but chronic fissures (>6–8 weeks) usually require surgery like fissurectomy.
Is fissurectomy better than lateral internal sphincterotomy alone?
Fissurectomy removes damaged tissue for better healing, while sphincterotomy reduces sphincter pressure. Combining both is often most effective.
How soon can I resume normal activities?
Most patients resume light activities in 1–2 days and normal routines (work, driving) in 1–3 weeks.
What are the signs of complications post-fissurectomy?
Excessive bleeding, fever, severe pain, or difficulty controlling bowel movements require immediate medical attention.
Can anal fissures recur after fissurectomy?
Recurrence is rare (2–5%) with proper surgery and lifestyle changes (e.g., high-fiber diet, avoiding constipation).
What lifestyle changes are needed post-fissurectomy?
Maintain a high-fiber diet, stay hydrated, avoid straining during bowel movements, and practice good anal hygiene.
Conclusion
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Looking for Best Hospitals for
Note: we are not promoting any hospitals
We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₱) | Maximum Price (₱) |
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Angeles City |
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Antipolo |
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Bacolod |
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Bacoor |
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Baguio |
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Butuan |
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Cagayan de Oro |
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Caloocan |
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Cebu City |
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Dasmariñas |
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Davao City |
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General Santos |
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General Trias |
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Iligan |
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Iloilo City |
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Las Piñas |
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Makati |
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Malolos |
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Manila |
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Muntinlupa |
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Parañaque |
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Pasay |
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Pasig |
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Puerto Princesa |
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Quezon City |
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San Fernando |
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San Jose del Monte |
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Taguig |
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Valenzuela |
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Zamboanga City |
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Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.