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Anal fissure

Mucosa defect – wound – located on the rear side of the anal canal, right above the anus. It is characterized by extreme pain, scorch-like, during and after defecation, with mild blood spots on the toilet paper. It can be felt with a finger as a node, nodule, painful to the touch.

It is formed due to strong tonus of the inner anal sphincter which stretches and pulls the gentle mucous membrane, which is why the defect is formed. It usually occurs due to constipation and difficult defecation, or, perhaps, after episodes of frequent loose stools.

Description of the procedure

Radiofrequent lateral sphincterotomy is a procedure done under general intravenous anesthesia due to extreme pain and sensitivity of the area.

It represents a partial incision of the inner anal sphincter, which leads to reduction of anal canal spasm. Stool passes through easily, with less irritation, enabling healing.

It is simultaneously possible, with fissurectomy, to remove hemorrhoids as well, if there is an indication.

By using a radiofrequent device, damage to surrounding tissue is reduced, and better precision is achieved. It shortens postoperative period and significantly reduces pain and bleeding.

Candidates

People with hypertonic anal sphincter – cases when after the administration of drugs that reduce spasm (nitroglycerin ointment locally, medications based on Viagra), symptoms of acute fissure persist longer than 4-6 weeks. Chronic fissure is formed – it includes fissure, hypertrophic papillae on the inner side and fibrous appendage on the anus.

Preparation

Act according to instructions previously given by an anesthesiologist: the day before the procedure, after light supper, it is, perhaps, necessary to take a mild laxative in order to ensure morning defecation. In the morning, it is advised to drink 3-5dl of Donat Mg and after that, stop taking liquid and eating. Common therapy, if necessary, take according to standard scheme or according to the arrangement made by anesthesiologist during the preoperative exam.

Recovery

Shortly after the procedure, the patient is, with an escort, discharged home with a recommendation for analgesic therapy during the next 2 days. After a couple of days, the patient is already capable of work and other activities.

Patient hygienic-dietary regime:
  • avoid ‘fast food’, pay attention to fiber intake, with a lot of residue
  • intake of minimum 2-2,5 l of fluid daily
  • do not postpone defecation
  • wash with warm water after defecation
  • avoid chemical laxatives
  • physical activity

Side effects and complications

As well as with other surgical procedures in this region, bleeding of different volume is possible. But, with correct preparation of the patient and adequately performed technique by an expert surgeon, this complication is negligible.

Package

Package includes: preoperative examination by an anesthesiologist, procedure itself, thromboprophylaxis if necessary, analgesics for 1-2 postoperative days and control examinations during the next 6 months.
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