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Sphincterotomy for Anal Fissure

Last updated April 1, 2018

Sphincterotomy for Anal Fissure procedure involves making an incision in the internal sphincter, in order to aid in quick healing of the anal fissure.


Background Information:

What are the other Names for the Procedure?

  • Lateral Internal Sphincterotomy
  • Sphincterotomy
  • Surgery for Anal Fissure

What is Sphincterotomy for Anal Fissure surgical procedure?

Sphincterotomy for Anal Fissure procedure involves making an incision in the internal sphincter, in order to aid in quick healing of the anal fissure.

What part of the Body does the Procedure involve?

Sphincterotomy for Anal Fissure involves the anus, inner lining of the anal canal, and the sphincter muscles.

Why is the Sphincterotomy for Anal Fissure surgical procedure Performed?

Sphincterotomy for Anal Fissure is performed to relieve the patient of excessive pain and discomfort caused due to the Anal Fissure.

What are some Alternative Choices for the Procedure?

Alternatives for Sphincterotomy for Anal Fissure procedure are broadly classified as surgical or non-surgical:

  • In a surgical procedure, an incision is made in the inner sphincter muscle and the fissure is left open to heal itself. Depending on the method employed they are variously known as Sphincterotomy, Fissurectomy and Advancement flaps, etc.
  • Non-surgical procedures include the application of topical medicines or nitroglycerine ointments, oral medication, sitz baths, calcium channel blocking based drug treatment, botulinum toxin injections, etc.

What are the Recent Advances in the Procedure?

A recent advancement in this procedure is known as the Advancement Flaps, where the fissures are replaced with healthy tissues to avoid incontinence. However, it must be noted that Anal Sphincterotomy is a widely used surgical technique, having a very high success rate.

What is the Cost of performing the Sphincterotomy for Anal Fissure surgical procedure?

The cost of Sphincterotomy for Anal Fissure procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding Sphincterotomy and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.bupa.co.uk/individuals/health-information/directory/a/anal-fissure-surgery

http://www.drugs.com/cg/anal-fissure.html

Prior to Sphincterotomy for Anal Fissure surgical procedure:

How is the Sphincterotomy for Anal Fissure surgical procedure Performed?

  • The patient is administered either a local, or general anesthesia depending on how chronic the fissure is (short- or long- lasting, based on duration of the fissure)
  • The anus and its neighboring area are cleansed with an antiseptic solution. The sphincter muscles are separated and an incision is made in the inner sphincter muscles. The sphincter muscles are primarily responsible for controlling the bowel movements by their relaxation and contraction
  • When an incision is made, it tends to relax the internal sphincter muscles, thereby reducing the tone in the sphincter. Anal Fissure increases the tone to the sphincter muscles and so with each bowel movement, patient might experience severe pain, and discomfort
  • If there is an associated constipation, the patient will strain with each bowel movement and this increases the size of the fissure thereby preventing it from healing
  • With this procedure, the tone decreases, the pain and discomfort is instantly relieved. By way of simultaneous avoidance of constipation, there is not much straining also involved during bowel movement and these factors causes the fissure to heal
  • The surgical wound is then left open to accelerate the healing process. In case there is bleeding, the wound is bandaged

Where is the Procedure Performed?

  • Sphincterotomy for Anal Fissure is usually performed in an out-patient surgery center facility, a physician’s clinic/office, or a hospital. Normally, the person can go home once the procedure is completed.
  • However, in some cases the patient may be kept under observation for a period of time, under advice by the physician.

Who Performs the Procedure?

Sphincterotomy for Anal Fissure is performed by a general surgeon, assisted by an anesthesiologist.

How long will the Procedure take?

The procedure normally takes about 45 minutes; unless any complications arise.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed. Blood tests may be performed to determine if there is a bleeding tendency or any other medical condition that prevents the person from undergoing the procedure
  • In case local anesthesia is used; do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
  • A physician will request your consent for Sphincterotomy for Anal Fissure procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Sphincterotomy for Anal Fissure procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Sphincterotomy for Anal Fissure surgical procedure?

  • Before the procedure, certain routine blood and urine tests may be recommended
  • The physician may also request an anoscopy or sigmoidoscopy

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What causes anal fissures?
  • What is a Sphincterotomy for Anal Fissure procedure?
  • What does the procedure involve?
  • How will this procedure help?
  • How soon should I get it done? Is there an emergency?
  • What choices do I have, apart from this procedure?
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • Would oral medications solve the problem?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • Who are the medical personnel involved in this procedure?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • What are the costs involved?

During the Sphincterotomy for Anal Fissure surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure the patient is administered a local or general anesthesia. Sometimes the patient may be given a spinal anesthesia instead.

How much Blood will you lose, during the Procedure?

The amount of blood loss is controlled, since the surgical incision made is generally not deep.

What are the possible Risks and Complications during the Sphincterotomy for Anal Fissure surgical procedure?

Some of the possible risks and complications that may arise during Sphincterotomy for Anal Fissure surgery are:

  • Accidental damage to the external sphincter muscle, which may result in bowel incontinence
  • Surgical wound infection
  • Hemorrhage
  • Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Sphincterotomy for Anal Fissure surgical procedure?

Generally there is no requirement for any post-procedure care at the healthcare facility; unless any complications arise.

After the Sphincterotomy for Anal Fissure surgical procedure:

What are the possible Risks and Complications after the Sphincterotomy for Anal Fissure surgical procedure?

The possible risk and complications that may arise post-surgery are:

  • Incontinence
  • Repeated fissure
  • Inability to control bowels till complete healing process has been achieved
  • Surgical wound infection
  • Abscess formation around the anus

What is the Prognosis after the Surgery?

  • Almost all of the patients, who undergo Sphincterotomy for Anal Fissure, are found to have a complete healing, within 4 weeks
  • However, it has also been noted that people who suffer from anal fissures have a higher chances of developing a fissure, in the future

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Inability to pass stools
  • Presence of blood in the feces
  • Bleeding from the anus
  • Severe pain
  • Spasms in the anus
  • Signs of infection around the surgical wound
  • If any discomfort is observed

What Post-Operative Care is needed at Home after the Sphincterotomy for Anal Fissure surgical procedure?

At home, the following post-operative care is recommended, after Sphincterotomy for Anal Fissure procedure:

  • Complete the course of prescribed oral medications
  • Avoid non-prescribed pain medication
  • Have sitz baths at least 3-4 times a day
  • Avoid strenuous activity for 4 weeks
  • Take stool softeners
  • After bowel movement, clean the area with a soft moist tissue

How long does it normally take to fully recover, from the Procedure?

It takes anywhere between 3-4 weeks for a complete recovery post-surgery.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue (if any removed), is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision
  • Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Sphincterotomy for Anal Fissure surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility or hospital
  • A general surgeon
  • An anesthesiologist (if anesthesia was administered)
  • A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before Sphincterotomy for Anal Fissure procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 23, 2013
Last updated: April 1, 2018