General Information

DEFINITION--Removal of an anal fissure, a crack or tear in the membrane that lines the anus, and incision of the muscular anal sphincter.

BODY PARTS INVOLVED--Anus and lining membrane; anal muscles (sphincter).

REASONS FOR SURGERY--Relief of pain.

SURGICAL RISK INCREASES WITH

• Obesity; smoking.
• Recent or chronic illness.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
• Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.

What To Expect

WHO OPERATES--General surgeon or proctologist.

WHERE PERFORMED--Hospital or outpatient surgical facility.

DIAGNOSTIC TESTS--Before surgery: Blood and urine studies; anoscopy; sigmoidoscopy (See Glossary for all).

ANESTHESIA

• Local anesthesia by injection.
• Spinal anesthesia by injection.
• General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• The sphincter is expanded with special instruments.
• The fissure is cut free from surrounding tissue and removed. Sometimes, the sphincter muscles are cut to prevent recurrence.
• Bleeding vessels are tied or closed with electrocauterization.
• A drain or packing is inserted into the surgical area.
• The surgical area is left open to hasten healing. Bandages are applied.

POSSIBLE COMPLICATIONS

• Excessive bleeding or pain.
• Surgical-wound infection.
• Inability to control bowel movements until healing is complete.
• Incontinence, if all or part of sphincter is removed.

AVERAGE HOSPITAL STAY--0 to 1 day.

PROBABLE OUTCOME--Expect complete healing without complications. Allow about 3 weeks for recovery from surgery.

Postoperative Care

> Use an electric heating pad, a heat lamp or a warm compress to relieve surgical--

wound pain.

• Use soft moistened tissue to clean the anal area after bowel movements.

> You may use non--prescription drugs, such as acetaminophen, for minor pain.

> To help recovery and aid your well--

being, resume daily activities, including work, as soon as possible.

• Avoid vigorous exercise for 4 weeks after surgery. > Resume driving 1 week after returning home.

DIET--Eat a well--balanced diet to promote healing. Increase fiber and fluid intake to prevent constipation.

Call Your Doctor If

> Pain, swelling, redness, drainage or bleeding increases in the surgical area.