First of all, The patients try to improve the condition with conservative treatment, such as advice received on lifestyle and diet, and drug therapy. Then, if the symptoms do not improve or worsen to the extent that they interfere with your daily living, you may have surgical treatment (surgery) as the next step, depending on the decision by your primary doctor and your wish.
There are currently two major surgical treatments available for anal fissure. Detailed techniques, procedures, and techniques may vary depending on the decision of the primary doctor based on individual pathological conditions or the patient's wish. Therefore, read this just as a reference. Let's look at each method.
(1)Lateral internal sphincterotomy (LIS)
(2) Sliding skin graft method (SSG)
This is for patients who repeatedly have bleeding anal fissures during bowel movement due to excessive tension of the sphincter. The surgery is performed to cut the lateral internal anal sphincter a little with a scalpel to remove the anal stenosis associated with spasm and contraction of the internal sphincter.
Prolonged and repeated anal fissures will become chronic anal fissures, which narrows the anus. This is called anal stricture. The surgery to alleviate this symptom is the sliding skin graft method (SSG) method. Anal stenosis is resolved by resecting all anal fissures and hardened areas (fibrosis) around them, and incising the internal sphincter a little.
The anal fissure is incised against the anus.
The incised part is sutured to cover all.
The skin on the outside of the sutured area is shallowly incised in an arc-shape, and the stretched skin is slid into the anus.
*It is just a schematic diagram so that you can understand the difference easily.
[Reference]
1) Guidelines for Diagnosis and Treatment of Anal Diseases and Rectal Prolapse 2020
