Excision of chronic anal fissure

Anal fissure is a mucosal defect of varying length and circumference at the junction of the anus and rectum. Most often, the defect has a linear shape, but there are wedge-shaped or elliptical wounds. The pain that first develops is acute and occurs mainly during bowel movements or begins 15-40 minutes after the act.

The chronicity of an anal fissure is indicated by the frequency and duration of pain. Symptoms persist for more than 1.5-2 months. Sphincterospasm is noteworthy, making it difficult to pass stool and increasing pain. Chronic anal fissure requires adequate treatment to avoid complications.

What are chronic anal fissures

Chronic anal fissure is a gross violation of the integrity of the anal membranes along the rectum of varying length and shape. The defect is distinguished by a dense callous edge with a fibrinous coating at the bottom of the wound. The growth of granulomatous tissue is noted from the edges of the crack – a consequence of the regular accumulation of intestinal secretions. Sometimes hyperplasia of the edges of the fissure is mistaken for polyps, including due to the likelihood of their loss.

Treatment

Clinicians begin treatment of chronic anal fissure with conservative approaches. Primary measures include prescription of medications, physical therapy, massage and nutritional correction. Among the drugs of choice are:

Procto-Glyvenol

Cream for rectal use based on tribenoside and lidocaine. The drug has anti-inflammatory, analgesic and vascular tonic effects. The combined drug has a beneficial effect on the walls of blood vessels, improves tissue trophism, relieves pain and inflammation.

Rectal cream Procto-Glivenol is used in the treatment of various proctological pathologies.

Detralex

Detralex venotonic tablets based on diosmin and hesperidin, flavonoids are used to treat anal fissures, haemorrhoids, and bleeding. When used systemically, the drug solves the problem of tightness of the anoderm membranes, relieves pain, promotes the healing of trophic ulcers and eliminates pathologies of subcutaneous fat.

suppositories with sea buckthorn

Natural rectal suppositories with sea buckthorn soften the membranes of the anoderm, facilitating the process of defecation in case of cracks and haemorrhoids. The product improves blood flow and has a moderate anti-inflammatory and anti-edematous effect.

Suppositories with sea buckthorn are used as an adjuvant in the etiotropic therapy of various proctological diseases.

Dicloberl suppositories

Dicloberl suppositories are a non-steroidal anti-inflammatory drug with a moderate analgesic effect. Prescribed as symptomatic therapy for exacerbations, as well as to facilitate bowel movements.

Surgical treatment

The decision on the need for surgery is made in the absence of a positive result from conservative treatment options, as well as relapses after a seemingly successful resolution of the clinical situation.

The operation of choice for anal fissures is the method of excision of the fissure with dosed lateral sphincterotomy. During the operation, dilatation of the sphincter with excision of the valve can be performed.

About the surgical protocol – main aspects

Lateral dosed sphincterotomy today is the “gold standard” in modern treatment of anal fissure. This method was first proposed in 1951, however, with the main manipulation in the scar area. The technique is associated with a frequent complication in the form of anal incontinence – involuntary bowel movement.

Subsequently, a new protocol for lateral dosed sphincterotomy was transformed in 1969 by Mitchell Notaras. This method is still popular in clinical practice.

Lateral sphincterotomy is a radial excision of a chronic anal defect using a closed or open technique. The method allows you to achieve a stable reduction in tonic pressure on the sphincteral part of the anus and the connection with the rectum.

The operation can be performed either in combination with excision of the anal tubercles at the edge of the defect, or with formal excision of the anal fissure within healthy tissue.

The reasonable scope of surgical excision is the length of the defect, excluding injury to the muscle structures above the dentate line. The last aspect is important for the prevention of anal incontinence.

For the purpose of successful postoperative recovery, sphincterodilating (stretching and increasing elasticity) medications are prescribed. The most effective medications are those based on topical metronidazole.

Topical antibiotics as part of the prevention of intra- and postoperative complications also narrow the period of early rehabilitation and relieve pain.

The operation is performed under general anesthesia in a hospital setting. The choice of anesthesia method is selected depending on the patient’s clinical history.

Rehabilitation

For successful recovery after excision of a chronic fissure using dosed lateral sphincterotomy, patients are recommended to:

• sitz baths with medicinal herbs, manganese;
• saturation of the diet with dietary fiber (dietary fiber);
• drink plenty of water;
• diet dominated by liquid and semi-liquid dishes.

The surgical method is also promising in terms of low risks of complications, such as incontinence, fistulas, and disruption of the innervation of the pelvic organs.

Why you should contact our clinic

Our medical center provides a wide range of services, including treatment of proctological diseases. We perform highly specialized operations for haemorrhoids, anal fissures, intestinal polyps, and bleeding. Types of operations:

• operation using the HAL-RAR method
• Thrombosed external node – thrombectomy if indicated;
• Longo operation in selected patients with internal prolapse;
• transanal Doppler-controlled disarterization of internal haemorrhoids
• Stage 3-4 haemorrhoidectomy operation according to Milligan-Morgan using the Liga Sure device.

All operations on the intestines and anus are performed under spinal-epidural anesthesia with the installation of an epidural block. Our patients do not feel pain or discomfort in the first days after surgery.

Our specialists successfully treat the following diseases:

• anal fissure, acute, chronic;
• pararectal fistulas;
• coccygeal epithelial ducts;
• presacral cysts using laparoscopic protocols;
• rectal prolapse with advanced haemorrhoids and others.

Call and make an appointment on the website or by calling the clinic. We are happy to help you solve the most delicate health problems.

The estimated cost of surgical treatment of anal fissure is shown on the prices page. The final calculation depends on the volume of intervention, pain relief and concomitant conditions; it will be agreed upon before treatment.