Sphincterotomy - Anal Fissure Surgery

Overview

What is an anal fissure? In the most general terms, it is a tear in the thin tissue lining the anus. This tissue is called the mucosa. Most fissures occur when trying to pass large or hard stools during a bowel movement. When a tear occurs, you may experience a sudden and intense burst of pain around your anal sphincter. This can be accompanied by occasional spasms around the anal muscles. Pain may last up to several hours after your bowel movement. Bleeding is quite common.

 Anal fissures can affect people of any age. In most cases, anal fissures will heal on their own given time and care. Most doctors will tell you to add more fiber to your diet to soften stool, and to take sitz baths after bowel movements to help relieve pain. However, this experience is not universal, and surgical treatment may be necessary if the fissure does not heal on its own.

Why?

An untreated anal fissure that does not go away can cause excessive bleeding, dizziness, and fatigue. It can also trigger a cycle of discomfort – usually driven by a fear of bowel movements, which causes constipation, which then further agitates the fissure once the hardened stool is passed. Moreover, the tear may extend into the ring of muscle that holds your anus closed, causing you to lose control over your sphincter.

The ultimate goal of an anal fissure surgery is to increase the quality of life of the patient and to relieve as much pain as possible. If pain is disrupting your daily life and you have exhausted all other options, it may be time to consider surgical treatment.

All surgeries, whether they be big or small, carry risks. For anal fissure surgery, or a sphincterotomy, these typically include:

What to expect prior to your surgery

You may need to take antibiotics before surgery. Routine blood work is usually not needed but may be ordered prior to surgery based on the patient's age and the presence of any existing medical problems.

A sphincterotomy is a minor kind of surgery, and is done on an outpatient basis (you will be able to go home after the surgery is completed). Before your surgery, a nurse or doctor will plan the site, clean the affected area, and consult with you for any questions you may have. Then, they will numb the area using a local anesthetic so that you won’t feel any discomfort during the procedure. General anesthesia is reserved for more severe cases, but may be administered under the recommendation of your surgeon.

The procedure itself can last anywhere between a few minutes to an hour depending on the size of the fissure at the time of surgery. Typically, your doctor will give you a heads up on how long the procedure should last.

The procedure

There are multiple types of sphincterotomy procedures – these include lateral internal sphincterotomy, fissurectomy, and a V-Y advancement flap. The lateral internal sphincterotomy is the most common procedure used to treat anal fissures by surgery. Bes sure to consult your surgeon about the treatments best suitable for you.

A lateral internal sphincterotomy may be performed as an open surgery or as a closed surgery, depending on a number of factors. With an open surgery, an anoscope – a clear hollow tube between three and five inches long and 2 inches wide – is inserted into the anal sphincter to allow the surgeon to see the muscle and the fissure. Once the site is assessed, an incision is made with a scalpel within the narrow confines of the anoscope. In contrast, during a closed surgery, the incision and subsequent surgery is performed without the use of an anoscope. This technique is usually reserved for specialists who have been trained to perform the surgery this way.

After the procedure

Recovery time for a sphincterotomy will vary, but you should feel back to normal within a few weeks. Residual pain may last up to a week after surgery. Be sure to keep the area clean and dry to avoid the possibility of infection. Itchiness or soreness is common, however let your doctor know if you experience swelling or excessive pain.

You will need to arrange for a ride home the day of your surgery and we recommend someone stay with you for the first 24 hours at home. When you leave the facility after surgery, we will want you to go home and rest. Avoid making any other plans on the day of your surgery. Starting the following day, you can increase your activity as you feel up to it.

You will likely be given a prescription for pain medication following your surgery. The recovery nurse will discuss a pain control plan following surgery specific to you and your needs including activities like ice applied over incisions and a medication regimen. Oftentimes we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication.