Fissure Laser Surgery - Procedure, Treatment, Recovery Time

Laser Fissure Surgery is an advanced surgical procedure to treat anal fissures. In this procedure, a laser beam destroys the scarred tissue area. Being a quick procedure, it is generally performed in an outpatient setting, meaning the patient can leave on the same day of the surgery.

Anal fissures are linear tears or open sores in the anus opening caused due to trauma or an injury. An anal fissure also causes pain, itching, and bleeding.

Anatomy and Physiology of Anal Region

The anal region, also known as the anorectal region, is a complex body area that includes structures involved in defecation (passing stool) and maintaining continence (control over bowel movements).

Here's an overview of the anatomy of the anal region:

1. Anus: The anus is the external opening of the digestive tract through which stool (faeces) is eliminated from the body.

   It is surrounded by muscles that help release stool and maintain continence.

2. Anal Canal: The anal canal is a short passage that extends from the anus to the rectum.
   It is lined with a mucous membrane and is where anal fissures and haemorrhoids can develop. Two muscular sphincters surround the anal canal:

   Internal Anal Sphincter: This involuntary smooth muscle sphincter is inside the anus and remains contracted to maintain continence. It relaxes during defecation.
   External Anal Sphincter: Voluntary skeletal muscles that surround the internal sphincter and can be consciously controlled to maintain continence.

3. Rectum: The rectum is the last part of the large intestine (colon) and serves as a temporary storage area for stool before they are expelled from the body.

   The rectum stretches as stool accumulates, triggering the sensation of needing to defecate.

4. Anal Sinuses: The anal canal contains small pockets called anal sinuses and crypts, which can become irritated or infected, leading to conditions like anal fistulas or abscesses.

5. Hemorrhoidal Tissue: Haemorrhoids are clusters of blood vessels, connective tissue, and muscle located near the anus and inside the rectum.
   They play a role in maintaining continence and can become swollen or inflamed, causing discomfort.

6. Perianal Skin: The skin around the anus is called the perianal skin. It is sensitive and prone to itching, rashes, and infections.

Laser fissure surgery, also known as laser fissurectomy, is a potential treatment option for individuals with chronic anal fissures that have not responded to conservative treatments.

Generally, chronic anal fissures are treated with the help of laser fissure surgery. In addition to anal fissures, the following conditions are also treated with laser surgery.

1. Piles or Haemorrhoids

2. Anal fistula

3. Pilonidal sinus

Laser fissure surgery might be recommended for individuals who:

1. Have Chronic Fissures: If an individual has experienced anal fissures for an extended period and the condition hasn't improved with lifestyle changes, dietary adjustments, and other conservative treatments, the doctor might consider surgical options.

2. Experience Severe Pain: Fissures can be extremely painful, particularly during bowel movements.

   If the pain is severe and affects the quality of life, laser fissure surgery might be an option.

3. Bleeding Persists: If your fissures are causing persistent bleeding, your doctor might suggest surgical treatment to promote healing and reduce bleeding.

4. Desire Quicker Healing: Laser fissure surgery is generally considered a minimally invasive option that can promote quicker healing compared to traditional surgical methods.

5. Wish to Avoid Traditional Surgery: Some individuals might prefer minimally invasive techniques like laser surgery over traditional surgical procedures.

   This is because they may offer advantages such as less pain, shorter recovery time, and reduced risk of complications.

6. Find Conservative Treatments Ineffective: Before surgery is considered, doctors typically recommend conservative treatments such as warm baths, stool softeners, increased fibre intake, and topical medications.

   If these approaches don't provide relief, surgery could be an alternative.

Note: It's important to note that each patient’s condition is different, and the decision to undergo laser fissure surgery should be made in consultation with a qualified healthcare provider.

The doctor will evaluate specific conditions, medical history, and overall health to determine whether laser fissure surgery is appropriate for an individual.

Laser fissure surgery is a minimally invasive procedure which usually takes about 15 to 30 minutes to complete depending on the patient’s age, other medical conditions of the patient and the severity of the condition.

This procedure is performed using a CO2 laser or 1470 nm diode laser to treat anal fissures under the influence of local or general anaesthesia. The laser beams destroy the scarred tissue area.

The following steps are carried out during the procedure:

1. Anaesthesia: Before the procedure begins, the patient will be given anaesthesia to ensure that they are comfortable and pain-free during the surgery.

   Depending on the case, local anaesthesia, regional anaesthesia (such as a spinal block), or general anaesthesia may be administered.

2. Preparation: Once the patient is anaesthetised, the surgical area will be cleaned and prepped for the procedure.

3. Laser Application: A specialised surgical laser is used to precisely target the tissue around the fissure and sealing of blood vessels to minimise bleeding.

   The laser can be used to remove any scar tissue or damaged tissue that is contributing to the fissure.

4. Wound Care: After the laser treatment, the surgeon may apply a bandage with medication to the surgical site to aid in healing and prevent infection.

5. Closure and Recovery: Unlike traditional surgical methods that involve cutting and suturing, laser fissure surgery typically does not require sutures.

   The area will be left to heal naturally, and the wound will close on its own over time. The patient will be monitored in a recovery room until the effects of the anaesthesia wear off and stability is regained to go home.

Before and on the day of laser fissure surgery, there are several important steps and preparations to be aware of. Here's what you can generally expect:

Before Laser Fissure Surgery

1. Doctor Consultation: A consultation with the surgeon is held before the scheduled surgery date.

   During this appointment, the patient’s medical history, current symptoms, and previous treatments are discussed for the anal fissure.

2. Physical Examination: The surgeon will perform a physical examination of the anal area to assess the severity of the fissure and determine whether laser fissure surgery is an appropriate treatment option.

3. Medical Tests: Depending on the patient’s medical history and overall health, the surgeon may order specific medical tests, such as blood tests or imaging studies, to ensure a good condition for surgery.

4. Preoperative Instructions: Detailed preoperative instructions from the surgeon or medical team are provided.

   These instructions might include guidelines for fasting before the surgery, what medications to take or avoid, and how to prepare for the surgery day.

On the Day of Surgery

1. Fasting: About 8 hours of fasting before the surgery may be required.

   This is to ensure your stomach is empty and reduce the risk of complications during anaesthesia influence.

2. Medications: The surgeon may instruct the patient to take specific medications on the day of surgery.

   However, any medications should be avoided unless explicitly approved by the surgeon.

3. Clothing: Wearing loose and comfortable clothing in the surgical facility is essential.

   This can help with comfort and make it easier for medical staff to prepare for the procedure.

4. Preparation: The patient will be taken to a preoperative area, where medical staff will prepare them for surgery.

   This might involve monitoring the vitals.

5. Anaesthesia: Administration of anaesthesia will be done before the procedure. The type of anaesthesia will depend on the surgeon's recommendation and medical history.

Note: It is important to ask questions before and after the surgery. Follow the surgeon's instructions carefully to ensure a smooth and successful surgical experience.

After laser fissure surgery, the recovery process and experience may vary depending on factors such as the patient’s overall health, the extent of the procedure, and how well the follow post-operative instructions are followed.

Here's a general overview of what can be expected after laser fissure surgery:

The Recovery Process in the Hospital

1. Pain Management Medications: Some pain, discomfort, and swelling around the surgical site may be experienced.

   Pain medications or local anaesthetics may be administered to help manage pain.

2. Bleeding: It's normal to experience minor bleeding or oozing from the surgical site.

   The medical team will provide instructions on managing this, such as using a clean pad or gauze.

3. Diet: Drinking drink fluids may be advised, along with resuming a normal diet as tolerated.

   Staying hydrated and consuming fibre-rich foods can help prevent constipation, which can strain the healing area.

Recovery Process/Expectations After Hospital Discharge

1. Medications: Follow the surgeon's recommendations for pain management and prevention of infections.

   The doctor may prescribe pain medications or over-the-counter pain relievers to help manage discomfort.

2. Hygiene: Maintain good hygiene by gently cleaning the surgical area after bowel movements.

   The patient may be advised to use a peri-bottle or sitz bath for cleaning

3. Stool Softeners and Fibre: To prevent straining during bowel movements, which could affect the healing process, the doctor might recommend stool softeners or fibre supplements.

4. Avoid Straining: Activities that could strain the surgical area, such as heavy lifting, vigorous exercise, and sitting for prolonged periods, must be avoided.

First Follow-up Appointment

1. The first follow-up appointment post-surgery will be scheduled within 1 month after the surgery.

2. During the follow-up visit, the doctor will view the surgical site and develop a strategy to manage complications.

3. The doctor might also change the medication or advise the patient to continue with the previous medication for some more time, depending on the condition and recovery of the surgical area.

4. The patient will also be informed regarding future visits to examine if the implant is in place and functioning properly.

Laser sphincterotomy offers several potential benefits for individuals suffering from chronic anal fissures that have not responded to conservative treatments.

While the specific advantages can vary depending on individual circumstances, here are some potential benefits of laser fissure surgery:

1. Minimally Invasive: Laser fissure surgery is considered a minimally invasive procedure.

   It involves using a laser to precisely target and remove the damaged tissue, often requiring smaller incisions than traditional open surgical techniques.

2. Reduced Pain and Discomfort: The focused laser energy can help promote healing and reduce muscle spasms around the anal sphincter.

   This leads to decreased pain and discomfort during bowel movements and in daily activities.

3. Faster Healing: Laser technology can help stimulate tissue regeneration and enhance blood flow to the affected area, potentially leading to quicker healing than conventional surgical methods.

4. Less Bleeding: The laser can cauterise blood vessels as it cuts, reducing bleeding during the procedure and potentially in the post-operative period.

5. Shorter Recovery Time: Due to the minimally invasive nature of laser fissure surgery, patients may experience a shorter recovery period than traditional open surgeries.

6. Reduced Risk of Infection: Laser technology's precision can help minimise tissue damage and reduce the risk of infection at the surgical site.

7. Improved Quality of Life: By addressing chronic anal fissures and their associated symptoms, laser fissure surgery can improve quality of life, reducing pain, discomfort, and disruption to daily activities.

While laser fissure surgery (laser fissurectomy) is generally considered safe and minimally invasive, like any medical procedure, it carries potential risks and complications.

Here are some possible risks and complications associated with laser fissure surgery:

1. Infection: Any surgical procedure carries a risk of infection at the surgical site. Proper wound care and following post-operative instructions can help minimise this risk.

2. Bleeding: While laser technology can reduce bleeding during the procedure, some is still possible. In rare cases, severe bleeding may require medical attention.

3. Recurrence of Fissures: Although laser fissure surgery aims to promote healing and prevent recurrence, there is still a possibility that new fissures could develop in the future.

4. Pain or Discomfort: While the surgery aims to reduce pain, there could be temporary discomfort or pain during the healing process.

5. Allergic Reaction: Rarely, there could be an allergic reaction to anaesthesia, medications, or materials used during the surgery.

Note: It's important to have a thorough discussion with the doctor about the potential risks and benefits of laser fissure surgery. The surgeon will evaluate the individual situation, provide personalised recommendations, and help make an informed decision.

When is Consultation with the Doctor Needed?

A patient should follow up with the proctologist if he/she experiences any complications:

1. Pain

2. Infection at the surgical site

3. Bleeding

4. Involuntary passing of faeces

5. Difficulty in passing urine

Delaying laser fissure surgery, especially if you have chronic and persistent anal fissures, can potentially lead to various complications and negative effects on your health and quality of life.

Here are some risks associated with delaying laser fissure surgery:

1. Persistent Pain and Discomfort: Chronic anal fissures can cause ongoing pain, discomfort, and even severe spasms during bowel movements.

   Delaying surgery means living with these symptoms for an extended period.

2. Reduced Quality of Life: The pain, discomfort, and fear of bowel movements associated with chronic anal fissures can significantly impact your overall quality of life.

   This might affect your ability to work, socialise, and engage in normal daily activities.

3. Risk of Infection: Chronic fissures can increase the risk of infection in the anal area.

   The longer the fissure persists, the higher the chance of infection, which can complicate your condition.

4. Scar Tissue Formation: Over time, chronic fissures can lead to the development of scar tissue.

   Scar tissue can contribute to anal stenosis, a narrowing of the anal canal that can cause difficulties with bowel movements.

5. Chronic Constipation: Chronic fissures can sometimes be associated with constipation. If left untreated, ongoing constipation can lead to additional health problems.

The cost of laser fissure surgery ranges from ₹30,000 to ₹1,40,000. The cost varies based on the following factors:

1. Patient’s age

2. Other medical conditions that the patient may have

3. The severity of the anal fissure

4. Technique and equipment used

5. The type of hospital facility availed - individual room or shared

Laser fissure surgery stands out as a minimally invasive and precise approach to treating anal fissures. The focused laser energy not only accelerates healing but also reduces post-operative discomfort.

Moreover, the reduced risk of complications, minimal scarring, and personalised treatment adjustments make laser fissure surgery an appealing option.

Individual suitability should be determined by consulting a medical professional. Experts at HexaHealth can help you understand the best treatment options available for your condition.

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