Post fissurectomy for chronic Anal fissure

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Hello everyone I am writing to Express my concerns about healing time post fissurectomy. I suffered nightmare posterior anal fissure for 3 months it affected my life badly. I tried all kind of medication includingBotox injections I lost 15 kg because laxatives and avoidingfood. At the end I went for surgery 3 weeks back the findings was fibrous tissues around the fissure which hyptrophied and it became like small lump. The surgeon excised the fissure with surrounding tissue. Immediate post operative pain was controlled by morphine. I continued to take diclofenac and paracetamol regularly for 3 days but be cautious about diclofenac because I had severe epigastric pain so I took gaviscon and esomprazole make sure to have full stomach too when taking it. I took tramadol post bowel motion also. The pain started to improve in 1 week period. but still the out fissure opening didn't heal yet in 3 weeks time the pain is much better. so I am wondering how long it will take to heal completely.

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  • Posted

    Well, unfortunately fissurectomy leaves you with an open wound, since they excise the scar tissues around the anal fissure and all of the other findings present. The place is very innervated so pain is to be expected. Did they combine the fissurectomy with sphincterotomy? In general the healing process is slow, since the anal fissures are of ischemic nature, this means the blood supply is rather bad and it doesn't heal like a normal cut would. After fissurectomy you basically have a fresh wound. It is possible that the fissurectomy fails if it's not combined with sphincterotomy. You have to cosnult your surgeon, may be you could try some topical treatment with diltiazem/nitroglycerine ointment.

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    • Posted

      Thank you very much for I your kind quick response. I am still using Nitroglycerine ointment and sitz bath 2 to 3 times every day. The surgery was fissuerectomy only. My surgeon preferred to preserve the sphincter as he relied on Botox injection that I have taken before. As you said I just read one paper stating long time of healing post fissurectomy about 5 weeks to 10 weeks in comparison of healing acute fissure spontaneously in few days to one week sometimes. But I feeling great improvement in term of pain and post BM spasm.

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    • Posted

      There isn't a certain term in which the fissure should heal. It depends on the case. An anal fissure can also be a small tear, which might bleed for several days and then heal on it's own. In some cases there won't be any pain or bleeding and the patient won't even know he had a tear. Obviously, this isn't your case. Larger and deeper fissure may actually take months (3-6) to completely heal. From what I've read I think you are in good hands with your doctor. If spasm and pain are reciding, then this is a good sign. I mentioned the nitro ointment, but I should say in some cases touching the fissure and pushing stuff inside might be contra-productive. Other than that you could also try fiber supplements (metamucil or psyllium) instead of laxatives. Try to have a balanced diet instead of starving yourself. You can keep a diary and try to find what works for you. And lastly - try to be more positive and dont be obssesed with your defecation and fissure healing.

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    • Posted

      Thanks, your advice touch my feelings indeed. I am obsessed and at some stage I was really depressed. I will try to get those fibre. Again thanks for your kind advice.

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