Anal Fissure surgery: cost, duration and step by step

• The appearance of anal fissure is one of the most painful conditions, so diagnosing and treating the problem in time are factors that make medical and surgical treatment more effective.
• Specialists agree that anal fissure surgery by sphincterotomy is the most recommended treatment, and that it guarantees the disappearance of discomfort and pain in most cases.
• This surgical technique has gained an advantage over others due to its short hospital stay, rapid remission of symptoms and minimal complication rate.

An anal fissure is a tear or partial rupture of the tissue surrounding the external orifice of the digestive tract called the anus. The tissue surrounding the anus is a mucous tissue, much weaker than the surrounding skin, is red or purplish in colour and easily broken.

This problem can affect both women and men equally and is located at the back of the anus. They occur as a consequence of the condition of the tissue from which the anus is formed and the anatomy and pathophysiology of the anus itself.

Anal fissures can be differentiated in several ways:

• Acute anal fissure: This is a fissure that has been present for less than 6 weeks and has never occurred in the last 2 years.
• Chronic anal fissure: These are fissures that occur frequently and persist for more than 6 weeks despite conservative treatment.
• Primary or idiopathic anal fissure: This is the name given to fissures whose appearance is due to mechanical factors or whose cause is unknown.
• Secondary anal fissure: This type of fissure is the result of a systemic disease, i.e. diseases that affect the whole body.

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The treatments that can be applied to an anal fissure depend directly on the type of fissure the patient has and the length of time they have been suffering from it. Below we will talk about these treatments and what they consist of:

Treatment of acute anal fissure

Conservative treatment of an acute anal fissure is mainly dietary and medical, which is why this type of therapeutic option is generally chosen when an anal fissure has occurred for less than 8 weeks. With the aim of hydrating the faeces, minimising the effort of exerting pressure when expelling them, and thus helping the fissure to heal.

• Abundant intake of water and dietary fibre: Abundant intake of water and fibre keeps stools less compact and hard, thus preventing constipation.
• Sitz baths: Take sitz baths with warm water in the perineal region for 10 minutes 1-2 times a day. Warm or hot sitz baths reduce the contraction of the internal anal sphincter, thereby improving the chances of resolution of anal fissures.
• Topical nitroglycerin and topical corticosteroids: The use of medicinal substances whose mechanism of action relaxes the internal anal sphincter.

Chronic anal fissure treatment

Chronic anal fissures occur when they remain active for more than 8 weeks from the beginning and cannot be solved with medical treatment. Surgical treatment by means of sphincterotomy is the most recommended:

• Lateral internal sphincterotomy: This is the most recommended treatment given its high degree of efficacy. This is a surgical technique in which the surgeon makes a cut in the outermost fibres of the internal and lateral portion of the anal sphincter. The aim of this intervention is to reduce the contraction of the internal sphincter and improve the scarce vascularisation that reaches the anal fissure due to the sphincteric contraction itself, which is the cause of the difficulty in closing anal fissures.

When conservative treatment does not resolve the condition of an acute or chronic, primary or secondary anal fissure, surgical intervention must be performed to ensure a correct and complete resolution. The technique normally used is lateral internal sphincterotomy. This treatment consists of partially or totally sectioning the internal anal sphincter on the same side as the fissure.

On the day of the surgery, the patient comes to the hospital where he/she will hand in the corresponding documentation in admissions and will then be accompanied to a pre-surgical room where he/she will be instructed to change into operating theatre clothes. After that, the patient will be taken to the operating theatre and the intervention will begin.

Once inside the operating theatre and after administering the anaesthesia, the surgery begins:

• As soon as the anaesthesia takes effect, the surgeon will dilate the anus using a bivalve anal retractor to expose the fissure.
• Once the surgeon has a complete view of the fissure, he proceeds to locate the intersphincteric groove that marks the division between the internal portion of the anal sphincter and its external portion.
• After locating this region, a minimal incision is made with a scalpel or electric scalpel no larger than 2-4 mm in the region of the internal lateral sphincter.
• Finally, the stitches are stitched.

After the intervention, the patients are taken to their room to recover from the effects of the anaesthesia, where they will be given the necessary care until they are discharged from hospital.

At the time of discharge, the patient will be given instructions on how to care for the wound until it has healed.

The surgery lasts around 30-45 minutes, and the patient usually goes home after the intervention, although in some cases, a 1-day hospital stay is possible. The pain gradually disappears after the surgery.

Recovery and full healing take between 3 and 4 weeks after surgery.

Everything mentioned above regarding the price of anal fissure surgery is based on the way Operarme, specialists in surgery, works: our interventions include everything necessary to carry out the surgical treatment of resection by sphincterotomy with the greatest possible safety and effectiveness for the patient, providing a fixed all-inclusive price of 2.190 €.

In this way, the patient knows from the outset the final cost of the intervention. Below you will find a breakdown of what is included in the price of the anal fissure surgery at Operarme:

• Booking and use of operating theatre.
• Single room with a spare bed with food and accommodation (for the patient) for up to 1 day.
• Stay in the post-surgical recovery room, monitoring and necessary treatments.
• Preoperative tests (blood tests, electrocardiogram and chest x-ray according to medical indications).
• Post-operative visits until medical discharge.
• Medical fees.
• Anaesthesiologist fees.
• Nursing team fees.
• Surgical material necessary for the intervention.

In addition, the company offers the patient a free transfer service for the day of admission and discharge from hospital, thus avoiding the need to take the car. Furthermore, the patient has continuous access to our Patient Service department, with whom he/she can solve any questions.

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