Fissure Laser Surgery - Procedure, Treatment, Recovery Time

Laser fissure surgery is a minimally invasive procedure which usually takes about 15 to 30 minutes to complete depending on the patient’s age, other medical conditions of the patient and severity of the condition. This procedure is performed using a CO2 laser or 1470 nm diode laser to treat anal fissures. The laser beams destroy the scarred tissue area. The procedure is also generally performed under local or general anaesthesia to keep the patient comfortable. The following steps are carried out during the procedure:

1. The surgeon will advise the patient to be in a lithotomy position (lying down on your back, with your hips and knees flexed and thighs spread apart). This position will help the surgeon to visualise the surgical site clearly.
2. The anesthesiologist will administer local or general anaesthesia depending on the pre-anaesthesia reports of the patient, to prevent any discomfort during the surgery.
3. Once the patient’s condition stabilises, the surgeon will then insert a laser into the natural opening of the anus.
4. Then, the surgeon will move the laser to the location of the fissure. 
5. An incision is then made (using the laser) in the anal muscles thereby loosening the sphincter muscles.
6. The fissure scar also heals during this process thus curing the patient. 
7. The patient will then be moved to the recovery room post-surgery.

The patient may expect the following before or on the day of the surgery.

Before Laser Fissure Surgery

A patient may expect the following before the surgery:

1. Preoperative examination: 
   1. A medical check-up with the proctologist will be required a few weeks before the surgery. 
   2. During the check-up, the patient will be asked to get a blood test, ECG (electrocardiogram), and chest X-ray done.
2. Medications: Medications can interfere with the surgical process. If a patient takes blood-thinning medications such as warfarin, he/she must stop them a few days before the surgery.
3. Dietary changes: 
   1. The proctologist will advise the patient to eat foods rich in minerals and vitamins such as fruits and vegetables a day before surgery.
   2. The patient will be asked to avoid red meat and such foods that are difficult to digest.
   3. The patient also should not consume alcohol three to four days before surgery.

On the day of Laser Fissure Surgery

1. The patient needs to reach the hospital before the scheduled time.
2. The patient will be asked to sign the consent form in the presence of his/her family.
3. The patient will be instructed to remove his street clothes and jewellery and wear a hospital gown or shorts.
4. A nurse will place an intravenous catheter in the patient’s hand or forearm and inject a mild sedative.
5. Vitals will be monitored.
6. The patient will then be shifted to the operating room.

A patient who has undergone laser fissure surgery can expect the following after the surgery:

The recovery process in the hospital

1. Post-surgery, the patient will be moved to the hospital ward so that he/she can recover.
2. The patient will be kept in observation until the after-effect of anaesthesia wears off.
3. The surgeon will prescribe antibiotics to prevent infection and analgesics to avoid pain and discomfort.
4. Once the patient's condition stabilises, the patient will be discharged after providing detailed information about the home care, scheduled medicines, and initiation of activities.
5. Most patients are discharged from the hospital on the day of the surgery. However, the patient may need to stay at the hospital for 2 to 3 days in some cases. The average time of stay at the hospital after surgery is around 12 hours.

Recovery process/expectation after hospital discharge

All the instructions provided by the doctor should be followed at all times.

1. The patient may experience some pain while passing stool at first, although it should be less than that before the surgery. Using stool softeners or laxatives can help the patient to have a less painful bowel movement.
2. The patient must stay hydrated and increase the intake of fibre-rich foods like fresh fruits and vegetables.
3. The anal fissures will heal completely within one to two weeks post-surgery.
4. The patient can most likely return to his/her daily routine within one to two days of surgery.
5. The patient can shower as usual; however, he/she must pat the anal area dry with a towel after showering.

First follow-up appointment

1. The first follow-up appointment post-surgery will be scheduled within 1 month after the surgery.
2. During the follow-up visit, the doctor will view the surgical site and develop a strategy to manage complications.
3. The doctor might also change the medication or advise the patient to continue with the previous medication for some more time, depending on the condition and recovery of the surgical area.
4. The patient will also be informed regarding future visits to examine if the implant is in place and functioning properly.

Laser fissure surgery is an advanced surgical procedure to treat anal fissures. This treatment method has several benefits which help improve the quality of life of an individual. The benefits of laser fissure surgery include:

1. Pain relief from fissures
2. No bleeding
3. Requires minimal invasion (no cuts or fewer cuts)
4. Lesser operative time (around nine minutes)
5. Reduces clinical symptoms
6. Shorter recovery time
7. Fewer dangers and side effects

Laser fissure surgery minimises the risk of complications compared to other surgical treatments of anal fissures. However, there are some risks and complications associated with laser fissure surgery. These include: 

1. Pain
2. Bruising
3. Swelling in the treated area. 
4. Difficulty in passing bowel after the surgery

When is consultation with the doctor needed?

A patient should follow up with the proctologist if he/she experiences any of the following complications:

1. Pain
2. Infection at the surgical site
3. Bleeding
4. Involuntary passing of faeces
5. Difficulty in passing urine

If anal fissures are not treated in time, they can be uncomfortable and may affect daily activities. Risks of delayed laser fissure surgery may include:

1. Severe pain during bowel movement
2. Burning sensation
3. The complication of chronic anal fissures
4. Infection
5. Development of anal fissure to anal fistula

The cost of laser fissure surgery ranges from ₹30,000 to ₹1,40,000. The cost varies based on the following factors:

1. Patient’s age
2. Other medical conditions that the patient may have
3. The severity of the anal fissure
4. Technique and equipment used
5. The type of hospital facility availed - individual room or shared