Laser surgery anal fissure

Effective and gentle treatment of anal fissures with the laser

Laser fissurectomy: indication, chances, risks, treatment procedure

Have you had recurrent pain or bleeding during bowel movements for years? You can literally feel the sensitive anal skin tearing or it feels like you have broken glass in your stool? When these symptoms first appeared, you used an ointment or changed your diet to a high-fibre diet and things quickly got better. Maybe the problem even disappeared on its own. 

But the discomfort keeps coming back or doesn't go away completely. At first the pain was forgotten after a few minutes, now it torments you for half the day. Even if you have very soft stools, you no longer feel well. Skin flaps or growths have appeared on the anus. In women, it is not uncommon for swelling to occur synchronously with menstruation.

All these symptoms indicate that the anal fissure has become chronic. It can't go on like this? By now you know every ointment that has helped someone, all the "stool softeners" and have treated yourself with anal dilators or fissure pens. Many things have helped somehow, but not in the long run?

Then it is time to face the facts. The likelihood that your anal fissure will still heal on its own or with some conservative treatment. A wound has become a chronic and scarring inflammation, similar to an ulcer. Niches or pockets have formed at the edges of the wound where intestinal bacteria can take hold even with the best hygiene.

Surgery is the only thing that can help. But when you hear the word surgery, all alarm bells ring. Won't the pain get worse with a surgical wound? How long will you be absent after an operation?) Is there a risk of incontinence? What surgical technique do the experts recommend(AWMF 2019 guideline on anal fissure)?

Compared to surgery with a scalpel, the low-bleeding laser technique offers the advantage of a better overview during the operation. The sphincter muscle is optimally spared. Compared to surgery of anal fissure with the electric scalpel, the thermal damage to the surrounding tissue is significantly reduced. A desirable side effect of laser irradiation is the reduction of surgery-related pain and the stimulation of wound healing, similar to Low Level Laser Therapy (LLLT).

A good proctologist will thoroughly examine the patient and give them all the facts about the surgery so they can make an informed decision. We have been using laser fissurectomy with the diode laser for almost a decade. It includes the

  • Peeling of the anal fissure
  • Converting a deep, tight wound into a smooth, shallow wound
  • Removal of all pathological growths
  • Dissolving scarring and restoring the elasticity of the anus
  • Sealing the wound edges to reduce bleeding
  • Open wound treatment to prevent infections
  • Fine tissue examination to exclude malignant degeneration
Laser surgery anal fissure with class 4 diode laser

Laser surgery for anal fissure: surgical procedure

Picture of a chronic anal fissure before surgery
Picture of a chronic anal fissure with pocket formation and outpost fold
Laser surgery with diode laser
The diode laser marks the incision
After the laser operation
Flat, smooth and blood-dry wound after laser surgery

Cutting out the anal fissure is now standard surgical treatment. The principle of the procedure is to turn a deep wound into a flat wound and to remove all obstacles that can interfere with the discharge of secretions and the passage of stools.

During this operation, changes such as the outpost fold or hypertrophic papilla are also removed using an electric scalpel. Such an operation can also be useful in the case of a deep crypt (a deepening of the mucous membrane), in which case it is referred to as crypt exposure. If an anal fistula has developed as a result of the anal fissure, it is also removed.

anal fissure: laser surgery

The accuracy of the operation can be increased by using magnifying glasses that make even the smallest details visible during the procedure. According to our observations, the use of a diode laser instead of an electroscalpel also ensures a better end result, as wound healing begins earlier and the scars become smooth and elastic.

After the operation

The wound is not sutured to avoid additional pain, infection and scar tissue. The external wound may appear quite large to the patient, but the resulting discharge of secretion is crucial for healing. After the bowel movement, the wound is cleaned only with running water under the shower, through a sitting bath or on the way simply with a damp toilet paper or baby cloth.

After the operation there is an inability to work for about two weeks. Normally the healing starts on the 10th postoperative day. Now the secretion of wound fluid and wound pain also decrease. Towards the end of the third week, the restrictions are usually hardly still in place. Only in a few individual cases is the scar completely healed after one year.

Do you have questions about the treatment of anal fissure? Do not hesitate to call us - we will be happy to discuss everything in detail with you.

Anal fissure surgery: chances of healing

In the case of chronic anal fissure, fissureectomy is the surgical procedure of first choice. Diode laser surgery offers additional advantages in terms of healing time and the functional and aesthetic quality of the scar.

Literature on laser fissurectomy

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DR. BERNHARD HOFER & COLLEAGUES

Specialists in surgery, proctology

Brienner Str. 13, D-80333 Munich, Germany

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