Fissurectomy with anoplasty
Aim of the procedure
What is an anal fissure?
An anal fissure is a tear in the lining of the anal canal which generally causes anal pain during bowel movements and is often associated with constipation. A chronic anal fissure may cause a fold of skin (sentinel anal skin tag) to develop over the fissure, or a skin tag (hypertrophied papilla) to form inside the anal canal. An anal abscess may further complicate the condition.
In the event of failed medical treatment, severe and recurrent pain, infection or an abnormal appearance, a fissurectomy with anoplasty may be proposed in order to replace the fissured mucosa. Doctors have been using this surgical technique for several years with good outcomes. The risk of relapse is estimated at less than 10%.
What does the procedure involve?
Performed under general or regional anesthesia, this surgical procedure consists in removing the fissure and the associated skin formations (sentinel tag or hypertrophied papilla). The fissurectomy consists in removing the fissure along with the surrounding skin. The anoplasty consists in partially covering the wound with a small piece of the mucosa (inner lining) of the rectum. The surgeon does not cut through the sphincter muscles.
What to expect after the procedure
The procedure is generally performed on an outpatient basis. It takes four to eight weeks for the surgical site to heal. Because of postoperative pain and seeping from the surgical wound, patients typically stay home from work for two to four weeks. Postoperative care is straightforward and mainly involves maintaining a clean wound, which can usually be achieved without the help of a nurse.
What are the possible short-term complications?
- Postoperative pain requiring stronger medications
- Inability to urinate for 10% of patients, which can be treated medically or with a temporary urinary catheter
- Hemorrhaging up to 20 days post-surgery, requiring additional emergency surgery in 1% of cases. Any long-distance trips or air travel must therefore be avoided for three weeks following the procedure.
- Constipation due to the formation of a plug of stool, treatable with enemas and laxatives
- Local infection, which is rare but may require additional surgery
- Delayed healing beyond eight weeks in 10 to 20% of cases, requiring additional surgery in rare cases
- As with any surgery, the following general complications may occur:phlebitis, pulmonary embolism, local or regional infection
- Symptoms including pain, light bleeding, intermittent seepage, difficulty distinguishing between gas and stool and possibly the urgent need to defecate are frequent until the wounds have fully healed. They are not considered to be complications.
What are the possible long-term complications?
- Incontinence issues are rarely reported and usually occur in the presence of pre-existing problems resulting from tearing caused by a difficult childbirth, chronic diarrhea or previous colorectal surgery. Don’t hesitate to speak to your surgeon about any issues you may be experiencing, which may impact your overall care
- Very rarely, a fistula may develop due to an infection of the surgical wound, generally requiring additional surgery
- Folds of skin around the anus are sometimes observed; no guarantees on aesthetic outcome can be made
- Persistent intestinal transit issues, while not considered to be a complication of the procedure, increase the risk of relapse, damage to the scar and the development of a fissure in another area of the anal canal.