What is an anal fissure surgery and when is it necessary?
The most important criterion for deciding on anal fissure surgery is the patient's subjective level of suffering. Doctors only operate on an anal fissure when absolutely necessary, as surgery carries the risk of injuring the anal sphincter muscle. In such cases, the patient may no longer be able to control bowel movements, potentially leading to fecal incontinence in the worst case. Therefore, anal fissure surgery is only performed if conservative treatment of anal tears with stool regulation and ointments or suppositories has been consistently applied for over 8 weeks without sustainable healing of the fissure. Surgery may also be considered if the patient complains of very pronounced symptoms of anal fissure, such as severe and persistent pain or itching, or if the frequency or intensity of bleeding from the fissure increases over time. Also, if the symptoms of anal fissure persist or there are recurring complaints over a longer period, anal fissure surgery may be the choice of the treating physician. Additionally, secondary tissue changes such as the sentinel pile or skin tags can also necessitate surgery.
How long does an anal fissure surgery take?
The duration of an anal fissure surgery can vary depending on the patient and the type of procedure or surgical technique used. In younger and medically stable patients, the surgery is often performed on an outpatient basis, meaning patients can go home the same day. The actual surgery usually lasts between 30 minutes and 1 hour, depending on the complexity of the fissure and the chosen surgical method. After the operation, there is a short monitoring period to ensure no acute complications occur and that the patient is in a stable condition.
Older patients or those with additional health challenges may require a short hospital stay for the surgery. This allows for more intensive monitoring and care to detect and treat potential risks such as circulatory problems or complications during healing after the surgery. The hospital stay usually lasts between 1 and 3 days but can vary depending on individual healing progress and the patient's overall health. During this stay, the patient is closely monitored to ensure no postoperative problems such as infections or bleeding occur and that adequate pain control is maintained. The duration of wound healing and postoperative monitoring can vary significantly depending on the patient. Read more in the blog post about anal fissure surgery experiences.
How long is one on sick leave after anal fissure surgery?
Most patients receive a sick note for the initial period after surgery. The length depends on individual factors such as the course of wound healing, whether there are complications, and the type of work the patient does. Generally, the doctor will issue a sick leave for several weeks after the surgery. Read more about examinations and diagnosis of an anal fissure in the blog post anal fissure doctor.
What surgical techniques are used for anal fissures?
Sometimes conservative treatment of anal tears is not sufficient to heal the tears in the anal mucosa. Surgical intervention is often the treatment of choice for chronic fissures. There are various surgical procedures for anal fissures. Treatment of a chronic anal fissure often requires surgery if conservative methods are not sufficiently successful. Anal fissure surgery can include different techniques, such as fissurectomy, lateral sphincterotomy, or modern laser treatment. Read more about the different surgical techniques for the treatment of chronic anal tears.
Fissurectomy
Most often, the surgeon performs the so-called fissurectomy. In this operation, the inflamed tissue as well as the surrounding scar tissue are removed as completely as possible. Fissurectomy is a proven surgical procedure for treating chronic anal fissures. The damaged tissue of the fissure is surgically removed to promote wound healing and prevent future complications. This procedure is especially suitable for patients for whom conservative treatments like ointments or suppositories have not provided sufficient improvement. The procedure is usually minimally invasive, but healing can take several weeks. After surgery, pain therapy is often prescribed to make the healing process more comfortable. Fissurectomy is a safe option that provides many patients with lasting relief. Find more information here on how to accelerate the healing of anal fissures.
Lateral sphincterotomy
Lateral sphincterotomy is a very effective surgical method for treating chronic fissures in the anus. In this procedure, the internal sphincter muscle is relaxed by a small incision to reduce pressure on the fissure and improve blood flow. This helps the fissure heal faster and significantly reduces the risk of recurrence. The sphincterotomy has a high success rate and is especially recommended for patients whose symptoms persist despite other treatments. Since the procedure is minimally invasive, complications are rare. In some cases, mild incontinence may occur, so this method is mainly used only for stubborn fissures.
Fissure cleaning (fissure debridement)
Fissure cleaning, also called fissure debridement, aims to eliminate all factors that impair the healing of the fissure. Existing scar tissue, the usually present sentinel skin tag at the outer end, and the enlarged anal papilla at the inner end of the fissure are among these factors. It is important to cut the edges of the fissure outward so that a corresponding outward-facing wound in the skin is created. This so-called drainage triangle allows wound secretions to drain from the fissure outward and is a crucial factor for successful wound healing. The wound usually heals completely within 4 to 6 weeks. Find more information here on how to accelerate the healing of anal fissures.
Covering the fissure with a skin flap (V-Y flap)
This procedure, known as the V-Y flap, involves covering the anal fissure with a small skin flap from the anal region to support wound healing. It is often used after fissure debridement when cleaning the fissure alone is not sufficient to ensure healing. Covering with a skin flap promotes tissue regeneration and protects the wound from further irritation. A key factor for the success of this surgery is soft stool after the procedure to facilitate healing and avoid additional pressure on the affected area. Therefore, stool-regulating agents and mild laxatives are usually prescribed to prevent constipation and promote wound healing.
Treatment of anal fissure with laser
A relatively new method for the treatment of anal fissures is laser therapy. This extends over a period of about six weeks, with one to two sessions per week. Generally, this laser method is less painful than conventional surgery.
Laser surgery for anal fissures is considered a minimally invasive procedure for treating chronic anal fissures. Compared to traditional surgical methods, this technique offers numerous advantages. The use of a precise laser spares the surrounding tissue, resulting in less bleeding and faster wound healing. Patients also benefit from less postoperative pain and a reduced risk of infection, as the laser keeps the wound area minimal and immediately seals blood vessels. The procedure is usually performed under local anesthesia or light general anesthesia and often allows outpatient treatment, so the patient can go home the same day. During the procedure, the surgeon removes scar tissue and improves blood flow, promoting healing of the anal fissure. After surgery, gentle care of the anal area is crucial to support healing. Although risks such as infections, scarring, or temporary continence problems exist, these occur less frequently and less severely with laser treatment than with conventional methods. Laser surgery thus represents an effective, modern solution, especially when conservative measures like ointments, suppositories, or stretching therapies are insufficient for healing the fissure.
How long does healing take after fissure surgery?
The healing process after fissure surgery usually takes about 4 to 6 weeks but can vary depending on individual factors. Immediately after the procedure, pain, swelling, and increased wound fluid discharge are common but can be alleviated by regular use of painkillers, anti-inflammatory medications, ointments, and suppositories. Read more about the treatment of anal fissures with suppositories or find more information here on how to accelerate the healing of anal fissures.
Especially in the first few days, careful wound care and anal hygiene are important to prevent infections, as the anal area is naturally heavily colonized with bacteria.
From about the tenth day, the wound begins to close, and the secretion of wound fluid decreases. Patients usually experience a significant reduction in pain at this point. Nevertheless, soft stool should still be maintained to avoid reopening the wound in the anal area.
A fiber-rich diet and plenty of fluids support the healing process and prevent unnecessary strain on the operated area.
About three to four weeks after surgery, wound healing has progressed further, and scar tissue has already formed. Most patients feel significantly better at this time, even though complete healing is not yet finished. Read more in the blog post about anal fissure surgery experiences.
In rare cases, such as when complications like infections occur or the wound reopens due to excessive strain, healing can take longer than six weeks. In such cases, additional medical treatment is necessary. The patient's overall health also plays a central role. People with diabetes or a weakened immune system often need more time to heal. Long-term, thorough care of the anal area and regular stool regulation are important to reduce the risk of recurrence or a new fissure. Most patients experience significant improvement and permanent relief from their symptoms after successful surgery and adequate aftercare. Read more here on how to prevent anal fissures.
What complications can occur with anal fissure surgery?
Overall, complications from anal fissure surgery are rare, but patients should be aware of the possible risks of the operation and discuss them with their doctor beforehand. Careful postoperative follow-up can significantly reduce the risk of such complications and positively influence the healing process. Find more information here on how to accelerate the healing of anal fissures. Read more about examinations and diagnosis of an anal fissure in the blog post anal fissure doctor.
Injury to the anal sphincter muscle and fecal incontinence
One of the most serious complications of anal fissure surgery is injury to the anal sphincter muscle, which in rare cases can lead to permanent or temporary fecal incontinence. The sphincter muscle controls bowel movement, and injury can impair continence. This risk is especially present in lateral sphincterotomy, where the internal sphincter muscle is partially cut. In most cases, incontinence is only temporary, and the muscle recovers during healing.
Scarring and narrowing of the anal canal
Another possible complication is scarring, which can occur if the tissue does not heal optimally after surgery. Excess scar tissue can impair the function of the anal area and lead to recurring symptoms of an anal fissure. In some cases, this scarring can even narrow the opening of the anal canal, requiring additional surgical interventions.
Infections and their consequences
Infections and consequently anal abscesses are a common risk in surgeries in the anal area, as it is heavily colonized with germs and bacteria. Even with careful hygiene, infections can occur, delaying healing and sometimes requiring treatment with antibiotics or even another surgical procedure. Typical signs of infection include persistent pain, swelling, redness, and pus discharge.
Recurrence of the anal fissure
Another complication after anal fissure surgery can be the recurrence of the fissure, also called a relapse. This happens if the wound does not heal properly or the underlying causes of anal tears, such as hard stool or chronic constipation, are not adequately treated. A relapse can cause renewed symptoms and often requires another surgical intervention.
Formation of an anal fistula
Among the rare but serious complications is the formation of an anal fistula. This occurs when an inflamed or infected wound forms a fistulous tract between the anal canal and the outer skin. Anal fistulas usually require separate surgical treatment, as they do not heal on their own and often lead to chronic complaints. Read more about the treatment of anal fistulas.
Bleeding after anal fissure surgery
Bleeding can occur during or after anal fissure surgery. While minor bleeding is normal and usually stops on its own, heavier bleeding may require follow-up treatment. This risk is especially increased in patients with clotting disorders or those taking blood-thinning medications and should be carefully weighed by your medical team beforehand. Find more information here on how to accelerate the healing of anal fissures.
Does health insurance cover the costs of surgery for anal fissures?
The costs of treatment in the context of anal fissure surgery can vary depending on the type and surgical technique used. However, the costs for surgery for anal fissures are generally covered by health insurance, as the treatment is usually considered medically necessary. This is especially the case if the anal fissure is chronic or causes significant symptoms that severely affect the patient's health and quality of life. Typical symptoms of anal fissure such as severe pain, persistent bleeding, or worsening of the fissure that cannot be sufficiently relieved by conservative treatments like ointments, suppositories, or sitz baths often justify the surgical intervention. Since the surgery is medically justified in such cases, statutory and private health insurance usually cover the costs of the procedure as well as the associated pre- and post-treatments. Patients should still coordinate with their health insurance in advance to ensure all costs are covered, especially if special procedures or techniques like laser treatment are used.
