What Is An Anal Fissurectomy?

An anal fissurectomy is a surgery that may be used for curing anal fissures. The procedure involves an incision in the sphincter muscles which control one's anal opening. It is normally the recommended surgery for treating tears or cracks that develop inside the distal canal (passageway) where waste is channeled for removal from your body.

Fissures only occur on the anus’ outer skin but it can also involve the entire thickness of the anus. During the procedure the outer areas of the rectum openings are cut through to relax and stretch tight internal tissues. This assists in avoiding excessive contractions. Surgery is normally undertaken for acute fissures which persist, frequently recur, or are chronic after a medical treatment that is not successful.

Conservative treatments are often tried first, but if they don’t correct the fissures, an anal sphincterotomy can be performed along with a fissurectomy to eliminate painful fissures.    

       

Causes

Anal fissures may occur when anal sphincter tissues start to spasm as stool passes, straining the anal canal. Fissure development is not associated with any work activity or any specific factor. It mostly occurs in individuals whose diets are low in fiber and therefore whose stools are hard and tough to pass, or in individuals with persistent constipation. Swelling of the rectum lining, inflammatory bowel ailment (ulcerative colitis or Crohn’s ailment), leukemia, or other forms of cancer can also result in anal fissures. Tuberculosis or syphilis can cause fissures but only in rare cases. 

Anal Fissure Signs & Symptoms

The common symptoms include discomfort during and some hours after any bowel movement. The tears as a result of anal fissures are quite small but are very painful and can continue for more than one hour after going for a long call. This pain can make an individual very anxious, to the point of evading defecation; this can aggravate the condition further. Pain is usually great in anal fissures that are acute.

 Other symptoms are:

• Presence of blood in the stool, the toilet bowl, or on tissue paper
• Itchy fissures
• Muscular spasms on the anus end
• Ripped or cracked anal skin 
• Yellowish discharge having an unpleasant smell

Anal fissures that are chronic may develop into the muscles forming ulcers that can lengthen the healing process.

Screening methods and Diagnosing

The doctor will carry out a physical examination as well as evaluate your past medical history. Many anal fissures may be diagnosed by a doctor by separating the buttocks and inspecting the patient's anal region. Diagnosis is easy when the tear can be seen, and treatment can be started immediately. A rectal tissue sample will be taken for examination when the tear is not visible.   

Anal fissures may be diagnosed using an anoscope or by examination through digital rectal analysis. A gloved finger is inserted during digital rectal analysis. An anoscope has a lighted tube that helps the doctor see and inspect the fissure. If the procedure causes too much pain, the doctor can wait until the fissure heals, or reduce the patient's discomfort with the use of a topical anesthetic.   

The doctor has to rule out other issues that can result in fissures. Anal fissures are usually located on the front or back surfaces of the anus. If an individual's ailment is characterized by more than one fissure or if fissures are situated at the sides of the anus, then they could be suffering from a totally different ailment, i.e., inflammatory bowel ailment, syphilis, HIV infection, or anal cancer.    

Treatment Options

The nature of the fissure will determine the treatment that will be adopted, that is, whether it is acute (lasts for a few days) or chronic (lasts over six weeks).

The doctor may recommend that you soak in a tub of warm water as frequently as you can for ten to twenty minutes each time, especially after any bowel movement. This helps minimize stress and relax your sphincter muscles. Various topical applications, botox injections, and steroid creams can be prescribed to minimize discomfort, relax the sphincter tissue of your anus, and improve your blood circulation.

Eating foods rich in fiber such as fruits, brown rice, vegetables, whole grain bread, and oats can help heal fissures within few weeks.   

If other treatments do not give the required relief, surgery will be the only remaining option. Surgical procedures that may be resorted to include:  

• Lateral internal sphincterotomy: The doctor performs this procedure by eliminating part of your anal sphincter tissue to reduce spasms and pain. The pain is immediately reduced after the procedure.  
• Fissurectomy: The doctor surgically removes your anal fissure along with surrounding healthy muscles. This procedure is frequently carried out on adults but it is mostly performed on children. The pain slowly declines after this procedure.
• Advancement anal flaps: The doctor will get healthy muscles from various parts of your body to assist in blood flow and repair your fissure. This method is normally used for treating chronic fissures that have been caused by anal injury, usually after a woman has given birth.

Reason for Procedure

When the anal fissures of a patient involve the sphincter areas and move upwards inside the anal canal, they may not easily be heal. Conservative treatments are tried by doctors before they recommend a fissurectomy or sphincterotomy. Stool softeners or stool-bulking laxatives for relieving constipation, fiber supplements, increased water intake, topical ointments (nitroglycerine), and botulinum toxin (botox injection in chemical sphincterotomy form) treatment methods are also effective. These conservative treatments alongside medication will help interrupt the muscle's spasm cycle and assist in relaxing the anal sphincter. The last resort is anal sphincterotomy, fissurectomy, or both, to relieve pain and ease tissue contraction, with the aim of healing fissures.     

 

How the Procedure is Performed

An anal sphincterotomy is normally carried out under spinal or general anesthesia in a hospital or clinic, in an inpatient or outpatient basis. At the start, all skin tags linked to the fissures are eliminated. The procedure can be carried out as either open or closed.

In a closed procedure, incisions will be made in the sphincter's outer part to relax the tissues. The internal sphincter also gets pulled up for incision and relaxation. The surgeon doesn’t cut through the anal mucosa as it can result in fistula development post-operation.

During open surgery, an incision is normally done laterally to the internal sphincter. The sphincter is then looped, taken up inside the incision, then cut. When the cut is complete, the separate split ends fall back in the canal, after which the undisturbed internal sphincter may be palpated.     

The wounds should be left open after the procedure, in rare cases, closed using sutures. In other cases where anal fissures require removal, a fissurectomy will be performed, and all wounds will be closed through sutures or using electrically-generated heat to prevent bleeding. 

The doctor will advise the patient to keep the affected area washed after any bowel movement, eat foods high in fiber, and use a stool softener for the easy passage of stool as the wound heals.

 

Complications

Complications resulting from surgery can include infection, rapid heartbeat, and difficulty in breathing, due to a reaction to anesthesia or too much bleeding. Some individuals might develop anal fistulae. Others might develop permanent sphincter anal function problems that can cause difficulty in controlling gas passage as well as fecal incontinence. These complications can greatly affect one's life so it is vital to discuss the risks involved with the surgeon to avoid surprises.