Anal fissure is caused by a spasm of the internal anal sphincter. The internal sphincter’s contribution to the retention of feces is insignificant compared to external sphincter whose function is extremely important. However, internal sphincter spasm is the main cause of fissures. In case that nonoperative treatments fail to cure an anal fissure, surgical treatment becomes mandatory.
The currently used technique of choice for the anal fissure is the partial lateral internal sphincterotomy. This is a minimal and very effective operation through a very small wound. During this procedure, the surgeon partially cuts the lower third of the relatively insignificant internal sphincter through a tiny incision. This cut is made on the left or right side of the anus and it may extend to the dentate line, but not farther. In the past, surgeons prefered the stretch of anal sphincters (Peter Lord operation) as an option. However, this operation can result in trauma to anal sphincters and fecal incontinence (loss of stool).
Following surgery, up to 97% of fissures heal. In one representative study, healing following surgery occurred in 98% of patients by two months. Recurrence rates after this type of surgery are low, about 0% to 3%. In our clinic, the postoperative results are spectacular and after two days there is no pain during and after defecation. We had no complication of fecal incontinence among our patients in Athens Colorectal Laboratory.
This operation is performed without general anesthesia and the patient returns in his home after a few hours. In selected cases surgery can be done with just local anesthesia.