Procedure Description

1. Your proctologist will use a CO2 laser or 1470 nm diode laser to treat anal fissures. The laser beams destroy the scarred tissue area.
2. The actions of the laser beam aid to stimulate the connective tissue layer that lies beneath the mucous membrane and skin to rejuvenate, regenerate, and form new blood vessels.

Laser surgery offers several advantages like:

1. Requires minimal invasion (no cuts or fewer cuts)
2. Lesser operative time (around nine minutes)
3. Reduces clinical symptoms
4. Reduces recovery time
5. Fewer dangers and side effects
6. Other surgical treatment options of an anal fissure include the following: 
7. Lateral internal sphincterotomy (LIS): In this surgery, the proctologist cuts through a portion of the internal anal sphincter muscle to relieve the spasm that is causing the anal fissure.
8. Botulinum toxin injections (Botox): This surgery involves injecting Botulinum toxin injection into the muscles surrounding the anus. This relaxes the muscles and relieves muscle tension.

What to Expect Before Surgery?

1. Preoperative examination: A medical check-up with your proctologist will be required a few weeks before your surgery. During the check-up, you may be asked to get a blood test, ECG (electrocardiogram), and chest X-ray done.
2. Medications: Medications can interfere with the surgical process. If you are taking blood-thinning medications such as warfarin, stop them a few days before the surgery.
3. Miscellaneous: Ascertain that you have someone to drive you home. You will be unable to drive or get home on your own due to anaesthesia and pain medication.

What to Expect on the Day of Surgery?

You will be asked to sign a consent form that will mention that you understand the details of the surgery and agree to go ahead with the procedure.

What to Expect During Surgery?

1. Anaesthesia: You will be given spinal or local anaesthesia to numb your anal region before surgery, which allows you to remain awake throughout the procedure. If given general anaesthesia, you will stay unconscious throughout the procedure.
2. Patient position: You will be placed in a lithotomy position (lying down on your back, with your hips and knees flexed and thighs spread apart).

What to Expect After Surgery?

1. You can expect the following at home
2. You may experience some pain while passing stool at first, although it should be less than that before the surgery.[17,19]
3. Using stool softeners or laxatives can help you have less painful bowel movements.[19] 
4. Stay hydrated and increase your intake of fibre-rich foods like fresh fruits and vegetables.[17,19]
5. Your fissures will heal completely within one to two weeks post-surgery.[11,12]
6. You can most likely go back to your routine within one to two days of surgery.[11]
7. You can shower as usual; however, pat the anal area dry with a towel after showering.[19]

First Follow-up Appointment

1. You should have a follow-up with your proctologist one month after the surgery. During this follow-up, your proctologist will check how your anal area is healing.[20]

When to See a Doctor?

1. Complications: Laser surgery minimises the risk of complications compared to other surgical treatments of anal fissure. However, you should follow up with your proctologist if you experience any of the following complications:
2. Pain
3. Infection at the surgical site
4. Bleeding
5. Involuntary passing of faeces
6. Difficulty in passing urine.