Patients suffering from anal canal pain always search for the term ‘what is fissure’ over the internet. A fissure is a cut at the anal canal due to excessive stretching of the anal Canal, secondary to constipated hard stool. We also called this cut an ulcer formation at the anal canal. This ulcer formation is the answer to your query about what is fissure.
What is fissure
The ulcer itself is called a Fissure. It is of two types, acute and chronic. Acute fissure has a history of less than one month and chronic fissure has a history of more than one month.
In chronic fissures, patients feel intense pain while passing stool and also experience post-defecation burning and pain at the anal Canal for about 1 hour. Both these fissures need fissure treatment.
Fissure surgery
The name of surgery required for the treatment of fissures is known as sphincterotomy. It is a very common procedure nowadays. It is done under spinal anaesthesia. And only one-day of hospitalization is enough for the treatment. The patient can go home safely on next day.
In some cases, a sphincter dilation procedure is also performed. Though still, practised this surgery, it is an old procedure and the recurrence rate after this procedure is high, hence not practised commonly.
Fissure surgery by laser
Nowadays we do all piles and fissure surgery by laser machine only. The principle of fissure surgery is the same, which means we do internal sphincterotomy, but by laser machine. It is a closed technique. We enter into inter sphincteric space by small calibre laser fibre and cut internal sphincter. In this way there will be no post-operative scar or pain. The patient gets immediate relief postoperatively.
How fissure is examined
To get examined you have to consult a surgeon, especially a proctologist. A proctologist is a consultant for any anorectal disease.
The proctologist will ask you to lie down on the left lateral side with your both knees flexed up to your abdomen. This is called the left lateral sims position.
In this position, you have to take down your undergarments and with good illumination, the doctor will examine your anal canal. First with the separation of buttocks and secondly with inspection of a proctoscope, a specially designed scope to visualise the anal canal.
If you are having intense pain while the examination, tell your doctor that you are not comfortable so he can avoid insertion of a proctoscope into the anal canal. After the examination doctor will assess the condition and will advise surgery according to your disease.
Investigations needed
If you are willing for surgery then some of investigations are needed to see your body profile and fitness for the surgery.
- Cbc,
- RBS,
- creatinine,
- HIV,
- Hbs,
- Covid-19 antigen,
- Hb a1c,
- X-ray chest,
- ECG,
- Echocardiography.
These investigations may not be required for all patients. Investigations orders according to the condition of the patient, age of the patient, and associated diseases of the patient.
Pre-operative consultation
This includes information regarding the type of surgery. The doctor will explain to you which surgery he is going to do. Is it open surgery, closed surgery or is it laser surgery?
He will also explain to you if any other pathology is seen intraoperatively then what will he do. For example, if piles are seen along with fissures, then he will treat that pathology too with the same sitting.
Pre-operative preparation
Pre-operative preparation means all the procedures which are required before taking the patient to the operation theatre.
Preparation of your private parts means the removal of hairs from the surgical site and pubic region. Hospital staff will ask you to remove your pubic hair or they will remove your hair.
You will be told not to take anything by mouth like meals, water, biscuit or anything you are habitual.
You will ask to go to urine before entering into the operation theatre.
Anaesthesia required
Generally, it is done under spinal anaesthesia. But in some patients, general anaesthesia may be required.
For example in children who are not comfortable with spinal anaesthesia, in old age patients whose spine is fibrosed or they are having any other cardiac Pathology which may be contraindicated for spinal anaesthesia..
Your position on the operation table
After giving anaesthesia you will be given a lithotomy position. in this position, your both lower limb will be hanged to the side bar of the operation table and your buttock will be pushed down up to the edge of the table.
In this position, you will be comfortable because you have been given Anaestasia which will anaesthetise the lower half of body only.
Later on anaesthetic doctor will give you to sedative injection to sleep during surgery. But this is not practised for all patients.
Surgeon position for surgery
The operative surgeon will sit in between your legs in front of your buttock.
Duration of surgery
Approximately it can takes 30 minutes to 60 minutes.
Post operative
After surgery, you can be shifted to the general ward or surgical recovery ward. Generally, it is not required to send the patient to ICU after this surgery. But if the surgeon feels there is a need to observe the patient up to the recovery from anaesthesia, then you can be shifted to ICU for observation.
Postoperatively you will be not allowed to take anything for 6 to 8 hours. This is required to complete recovery from spinal anaesthesia. Because after shifting to word, you will see that you are both legs are not moving and feeling very heavy. Even you cannot change your position because of lower body anaesthesia.
This anaesthesia slowly will step down and you will start feeling the sensation in your legs. You can slowly move your legs and finally, after a few hours, all your power of leg will be recovered.
Immediately postoperative, You will not be allowed to go to the washroom. You can take the help of a ward boy or nurse for urination. If you have already catheterised, then nothing to worry about.
You will be advised not to sleep over a pillow in case you are under spinal anaesthesia. Because keeping your head up over the pillow can cause you a post-operative spinal headache. But this is not common for every patient. It can happen in 5% of cases.
Postoperative pain
After the loss of anaesthesia, you can feel some discomfort at the operation site. You may feel some burning sensation there. This is normal for every anal surgery. You can ask the nurse to get an analgesic injection so that this pain will be reduced.
Sometimes you may feel some discomfort or pain in the middle lower abdomen. This could be because of the fullness of the urinary bladder if you are not catheterized. You take help nurse or inform your doctor regarding this so that they will help to drain Your urinary bladder.
You will get all injectables through an IV cannula along with saline bottles. You will not be allowed to take anything, any tablet by mouth. But if you are under treatment for diabetes, or hypertension, then you can take your own tablets under the guidance of your doctor.
What to observe by relative
When you get operated, many relatives come to visit you. In some Hospitals, single relatives is allowed to seat by the side of the patient. The main reason is to observe some important things.
When you are catheterised, relatives need to observe the urine bag whether it is getting collected by urine or not. Urine catheter whether it is getting stretched by your moment or not. Relatives can also note any soakage of dressing by the blood. So that he can immediately contact the doctor for any type of bleeding. This may happen once in a while.
Discharge plan
Routinely after fissure surgery, you can be discharged after 24 hours.
Post discharge advice
The doctor will give you oral medicines.
Some cream for application at the anal region.
And also suggest you to take a sitz bath.
This means you have to sit down after your defecation in a large plastic tub, full of warm water with Betadine solution in it.
You take this sitz bath for about 2 to 3 minutes, two times daily.
You will be called after 4-5 days for review. If you’re getting some pain then the doctor may remove a stich , if applied for sphincterotomy surgery.
When you can resume to duty
You can go to your job after 1 week safely.
Fissure surgery cost
This operation in a good mid-level Hospital will cost you around 40 thousand rupees. And a good corporate hospital will cost you around 50 to 60 thousand rupees. These expenses vary according to the hospital to hospital and doctor to doctor. The charges are not fixed for surgery. In Small Hospital owned by a surgeon, you can bargain for the charges.
This is all about hospitalisation for a fissure surgery. Please fill out the form below to get all such articles in your email box directly. Please comment about this article or send me suggestion at masram2017@gmail.com.
Thanks for your valuable time.
Dr. Pitambar.