Anal fissure surgery

An anal fissure is a small elongated tear in the skin of the anal canal, often caused by passing a hard stool. It causes sharp pain during and after bowel movements, sometimes lasting several hours, and occasionally slight bleeding. The pain triggers a reflex tightening of the anal muscle (sphincter), which prevents healing. Most recent fissures heal with medical treatment: regular bowel habits, gentle laxatives, and creams that relax the sphincter and relieve pain. When the fissure persists beyond a few weeks and becomes chronic, surgery may be offered. There are two main surgical approaches. Fissurectomy removes the fissure and its scarred edges, together with any associated skin tag or papilla, to create a healthy wound that can heal. Lateral internal sphincterotomy involves a limited, controlled division of part of the internal sphincter to reduce its tightness; it is offered case by case, after discussing its advantages and drawbacks. At Clinique Pasteur Tunis, the procedure is performed in the operating theatre, usually as day surgery or with one night in hospital, with clear advice on wound care and bowel habits.