How Does Fissure Surgery Work?

Introduction

Anal fissures are one of the most painful yet common anorectal conditions. Many people silently suffer from this condition due to embarrassment or fear of treatment. The intense pain, bleeding during bowel movements, and constant discomfort make life miserable for patients. While most fissures can heal with lifestyle changes, medications, and non-surgical methods, some stubborn or chronic fissures require surgical intervention.

What Is a Fissure?

A fissure is a small tear or cut in the lining of the anus, the opening through which stool passes. Though small in size, it causes severe pain and bleeding.

Symptoms of Anal Fissures

• Sharp or burning pain during and after bowel movement

• Bright red blood in stool or on toilet paper

• Visible tear or crack near the anus

• Swelling or skin tag near the tear (sentinel pile)

• Constant itching and discomfort

Common Causes

• Passing hard stools due to constipation

• Chronic diarrhea

• Straining during bowel movements

• Sedentary lifestyle and poor diet

• Underlying conditions like Crohn’s disease

  Why Surgery May Be Needed

• Fissure becomes chronic (lasting more than 6 weeks)

• There is recurrence despite medications

• Severe pain and bleeding continue

• The anal sphincter muscles remain in spasm, preventing healing

• Scar tissue forms around the fissure

  Types of Fissure Surgery

There are several surgical methods used to treat anal fissures.

1. Lateral Internal Sphincterotomy (LIS)

• Most common and effective surgery for fissures

• Involves cutting a small portion of the internal anal sphincter muscle

• This relieves the spasm, improves blood flow, and promotes healing

2. Fissurectomy

• The fissure and surrounding scar tissue are surgically removed

• Helps in regeneration of healthy tissue

3. Advancement Flap Surgery

• A healthy tissue flap from nearby skin is used to cover the fissure

• Improves blood supply to the area and speeds up healing

4. Laser Fissure Surgery (Modern Approach)

One of the latest and most patient-friendly options.

• A laser beam is used to remove fissure tissue and relieve muscle spasm

• No major cuts, stitches, or heavy bleeding

• Performed as a daycare procedure

Benefits of Laser Surgery:

• Minimally invasive

• Faster healing and less pain

• Minimal bleeding due to laser cauterization

• Very low risk of complications

• Patients resume routine activities within 2–3 days

Why It’s Preferred Today:
Laser fissure surgery has become popular because it provides all the benefits of conventional surgery without the fear of prolonged recovery or incontinence.

How Does the Surgery Work Step by Step?

Though techniques differ, the overall process follows certain steps.

1. Pre-Surgery Preparation

   • Consultation and diagnosis by a colorectal surgeon

   • Medical history evaluation

   • Sometimes basic tests like blood tests or colonoscopy

   • Fasting before surgery if anesthesia is planned

2. Anesthesia

   • Local, spinal, or general anesthesia may be used depending on the procedure

   • Ensures the patient does not feel pain

3. The Procedure

   • For LIS: The surgeon makes a small cut in the internal sphincter muscle to reduce tension

   • For Fissurectomy: The fissure and scar tissue are carefully removed

   • For Advancement Flap: Healthy tissue is grafted over the fissure

   • For Laser Surgery: A focused laser beam removes the fissure and relieves spasm

4. Post-Surgery Care

   • Patients are usually monitored for a few hours

   • Many procedures (especially laser) allow same-day discharge

   • Pain management with mild medications

Recovery After Fissure Surgery

Recovery is often smoother than patients expect. With modern methods, downtime is minimal.

What to Expect During Recovery:

• Mild pain or discomfort for a few days

• Minor bleeding or discharge is normal

• Bowel movements become less painful gradually

• Complete healing usually within 4–6 weeks (faster with laser surgery)

Post-Surgery Care Tips:

• Take sitz baths (warm water sitting) daily

• Eat a high-fiber diet to avoid constipation

• Drink plenty of fluids

• Use prescribed ointments or stool softeners

• Avoid lifting heavy weights initially

• Follow-up visits with the surgeon

Advantages of Fissure Surgery

• Permanent relief from pain and bleeding

• Faster recovery compared to ongoing medical treatments

• Reduced risk of recurrence

• Improved quality of life and mental peace

Can Fissures Be Prevented After Surgery?

Yes. Even after successful surgery, adopting a healthy lifestyle prevents recurrence.

Preventive Measures:

• Maintain a fiber-rich diet

• Stay hydrated

• Avoid prolonged sitting on the toilet

• Exercise regularly

• Treat constipation or diarrhea promptly

• Manage stress levels

Conclusion: “Healing Beyond Fear”

Fissure surgery may sound intimidating, but in reality, it is one of the most effective and life-changing solutions for chronic anal fissures.

So, how does fissure surgery work?
It works by relieving the muscle spasm, improving blood supply, and allowing natural healing. Whether through traditional methods like Lateral Internal Sphincterotomy or advanced approaches like laser fissure surgery, the goal remains the same to eliminate pain and restore quality of life.