Fissurectomy and Sphincterotomy
This procedure is performed for chronic anal fissures that are refractory to outpatient therapy. It is performed in the hospital on an outpatient basis using a general anesthetic or a spinal. It usually takes 30-45 minutes to complete. The sphincterotomy is done by making a small incision on the wall of the anal canal in the left lateral position and dissecting into the wall and locating the end of the internal sphincter muscle. This muscle is then cut in the cephalad direction, which helps to relax this muscle and improve blood flow to the fissure area.
The fissurectomy is done where the fissure is located and the edges of the fissure are removed and any tags distal to the fissure are removed also. The entire base of the new wound is then cauterized. Sometimes a hemorrhoid or hypertrophied anal papilla must be removed also. An absorbable suture is usually placed at the sphincterotomy site.
This surgery usually takes 4-5 weeks to heal and several post-op visits will be required. Although very rare, by cutting the sphincter muscle, post-op leakage and drainage can occur.