Fissurectomy

The fissurectomy entails the removal of the fissure as well as the skin that surrounds it. An anoplasty is a procedure in which a little portion of the rectum's mucosa (inner lining) is used to partly cover a lesion. The sphincter muscles are not sliced through.

Among the treatments for treating persistent anal fissures, fissurectomy is one of the alternatives. Many surgeons employed this method in patients who were at high risk of incontinence, such as the elderly, multiparous women, patients with normal anal tone, and those who had previously undergone anorectal surgery.

The fissurectomy was done using an electric scalpel, commencing with an incision of the anal margin below the fissure's border, then around it, and finally going over the dentate line. Within the same portion of tissue, any connected skin tags were removed.

Disease Overview:

Anal fissures

A tiny tear in the thin, moist tissue (mucosa) that borders the anus causes an anal fissure. When you pass hard or big stools during a bowel movement, an anal fissure might form. Pain and blood with bowel movements are common symptoms of anal fissures. Spasms in the ring of muscle at the end of your anus are also possible (anal sphincter).

Anal fissures are especially prevalent in babies, although they can happen to anybody at any age. Simple therapies, such as increased fibre intake or sitz baths, can help most anal fissures heal. Anal fissures may necessitate medicine or, in rare cases, surgery.

Disease Signs and Symptoms:

The following are signs and symptoms of an anal fissure:

• During bowel motions, there is pain, which can be rather severe.
• Pain that lasts for several hours following bowel movements
• After a bowel movement, there is bright crimson blood on the stool or toilet paper.
• Around the anus, there is a noticeable break in the skin.
• Near the anal fissure, a tiny lump or skin tag appears on the skin.

Disease Causes:

The following are some of the most common causes of anal fissure:

• Stools that are big or hard to pass
• Constipation and bowel motions that are strained
• Diarrhea that persists
• Intercourse anal
• Childbirth

Anal fissures can also be caused by the following less prevalent causes:

• Irritable bowel disease (IBD) such as Crohn's disease or similar inflammatory bowel illness
• Anal cancer
• HIV\sTuberculosis
• Syphilis

Factors that are at risk

Anal fissures can be caused by a variety of factors, including:

Constipation. Tearing is more likely when you strain during bowel motions or pass firm stools.

Childbirth. Women are more likely to develop anal fissures after giving birth.

Crohn's disease is a chronic inflammatory bowel illness. Irritable bowel illness produces persistent inflammation of the digestive system, which can render the anal canal lining more sensitive to ripping.

Intercourse in the anal region.

Age. Anal fissures can occur at any age, although they are more prevalent in children and the elderly.

Disease Diagnosis:

Your doctor will most likely inquire about your medical history and do a physical examination, which will likely include a mild examination of the anal area. The rip is frequently noticeable. This examination is usually all that is required to identify an anal fissure.

Acute anal fissures have the appearance of a new rip, similar to a paper cut. A chronic anal fissure is more likely to develop a deeper rip and fleshy growths on the inside or outside. If a fissure lasts longer than eight weeks, it is called chronic.

The position of the fissure reveals information about its cause. A fissure on the side of the anal orifice, rather than the rear or front, is more likely to indicate the presence of another ailment, such as Crohn's disease. If your doctor suspects you have an underlying disease, he or she may suggest additional testing:

Anoscopy. An anoscope is a tube put into the anus that allows your doctor to see the rectum and anus.

Flexible sigmoidoscopy is a kind of sigmoidoscopy that allows you to move A thin, flexible tube with a small video will be inserted into the bottom region of your colon by your doctor. If you're under 50 and don't have any risk factors for intestinal illness or colon cancer, you may be eligible for this test.

Colonoscopy. To evaluate your whole colon, your doctor will put a flexible tube into your rectum. If you're over 50, have risk factors for colon cancer, evidence of other illnesses, or other symptoms including stomach discomfort or diarrhoea, this test may be recommended.

Disease Treatment:

If you take precautions to keep your stool soft, such as increasing your fibre and hydration intake, anal fissures can heal in a few weeks. Soaking for 10 to 20 minutes in warm water many times a day, especially after bowel motions, can help relax the sphincter and encourage healing.

If your symptoms don't go away, you'll probably require more therapy.

Non-surgical options

Your doctor may advise you to:

• Nitroglycerin (Rectiv) is given externally to aid enhance blood flow to the fissure and facilitate healing, as well as relax the anal sphincter. When other conservative measures fail, nitroglycerin is typically regarded the medical therapy of choice. One of the most common side effects is a strong headache.
• For pain relief, topical anaesthetic creams may be useful.
• Botulinum toxin type A (Botox) injection to calm spasms and paralyse the anal sphincter muscle.
• Oral nifedipine (Procardia) and diltiazem (Cardizem) are two blood pressure drugs that can assist relax the anal sphincter. When nitroglycerin is ineffective or produces substantial negative effects, these medicines can be given orally or administered topically.

Surgery

Your doctor may consider surgery if you have a persistent anal fissure that is resistant to previous therapies or if your symptoms are severe. Doctors commonly conduct a lateral internal sphincterotomy (LIS) operation, which includes removing a tiny piece of the anal sphincter muscle to relieve spasm and improve recovery.