Anal Fissure Surgery

1. Physical examination: The doctor will inspect the anal region to check if there is any visible tear. The patient’s symptoms and medical history are also noted.
2. Anoscopy: A tubular device, called an anoscope, is inserted into the anus to help the doctor visualize the anus and rectum.
3. Flexible sigmoidoscopy: A flexible, thin tube with a tiny camera is inserted by the doctor into the bottom portion of the colon in this test.
4. Colonoscopy: A flexible tube is inserted into the rectum to inspect the entire colon in this test.

Anal fissures can be treated in the following ways:

1. Non-surgical treatment:

It can be performed in the following ways:

1. Hydrocortisone (corticosteroid) containing creams, suppositories, or foams can help in the reduction of inflammation.
2. Other types of creams and ointments that may aid in the treatment of anal fissures include: 
3. Medicated creams aid in anal fissure healing.
4. Topical muscle relaxants may be used to relax the anal muscles.
5. Nitroglycerin or calcium channel blocker ointments may be used to relax the anal muscles and increase the healing rate by providing blood flow to the anorectal region.
6. Anesthetic ointments aid in reducing the pain that could interfere with bowel movements.
7. A botox (botulinum toxin type A) injection may be given into the anal sphincter. This injection paralyzes the anal sphincter muscle temporarily and provides pain relief. This aids in the healing of the anus.

2. Surgical Treatment :

Surgery may be recommended to treat anal fissures when the conservative, non-medical approach has failed. The surgeries are usually performed under general anesthesia, that is, the patient is made unconscious during the procedure. The different types of surgeries that can be performed include:

1. Lateral internal sphincterotomy:
It involves cutting the sphincter muscles from the outermost anal edge and allowing the anal fissure to heal.
This procedure can be performed in the following two ways:
a) Open sphincterotomy: The surgeon will make a small incision or cut in the skin to view the sphincter muscles. This cut is normally left open for healing.
b) Closed sphincterotomy: The surgeon will pass a blade under the skin and reaches the sphincter muscles to cut them.
This procedure may lead to incontinence (lack of control over urination).

2. Fissurectomy:
The anal fissure edges are surgically excised along with any skin tags that may be present due to anal tears. 
The sphincter muscle will not be cut in this procedure.
A cauterization tool is then used for sealing the entire wound area.
Lateral internal sphincterotomy gives immediate pain relief, compared to gradual pain relief achieved by fissurectomy. 
The chances of anal fissure recurrence are higher following a fissurectomy.

3. Anal advancement flaps:
A small portion of healthy skin is grafted in the place of the damaged skin in the anal fissure in this procedure.
This procedure is less likely to cause incontinence.

4. Laser surgery for anal fissure treatment:
This surgery is usually under local anesthesia, that is, the area of treatment is numbed during the procedure.
A carbon dioxide (CO2) laser is usually used in this procedure. It is used to concentrate on a fixed surgical area and offers more control over the surgery.
The infrared radiation from the laser is used to increase the blood flow to the anal fissure area. This helps in the proper healing of the anal fissure.
The healing is quicker and the chances of anal fissure recurrence are less in this procedure.

Anal fissure surgery may have the following complications:

• Fever
• Chills
• Blood in stools
• Inability to urinate
• Incontinence (leakage) of stools 
• Fainting
• Prolonged pain
• Dizziness
• Increased bleeding
• Blood clot formation
• Pus discharge 
• Tear that extends to the surrounding muscle
• Recurrence of anal fissure 

• You may have some tenderness in the anal area for one or two days after the surgery. The doctor will prescribe pain-relieving medications to relieve your discomfort.
• Constipation and bleeding are commonly seen for the first few days after the surgery. 
• You should avoid straining while passing stools.
• Heavy lifting should be avoided for one or two days after the surgery.
• Most patients can resume work approximately two weeks after the surgery.
• Complete recovery after anal fissure surgery can take about six to ten weeks.

Home-remedies:

1. Have a healthy lifestyle
2. Exercise regularly
3. Eat a high-fiber, nutrient-rich diet
4. Take warm water baths
5. Avoid tobacco and alcohol consumption
6. Avoid processed food and red meat
7. Avoid straining while passing stools
8. Wipe your bottom gently from front backward after using the toilet

Cost :

The cost of anal fissure surgery in Mumbai is between INR 25,000 to INR 1,00,000.
The cost of anal fissure surgery in Delhi is between INR 20,000 to INR 90,000.
The cost of anal fissure surgery in Bangalore is between INR 20,000 to INR 90,000.
The cost of anal fissure surgery in Chennai is between INR 18,000 to INR 85,000.