If patients with an anal fissure do not respond to medications, the doctor may prescribe a fissure laser method to continue the course of treatment. Low-power lasers are used merely to facilitate the healing process and high-power lasers are applied for performing the surgical operation.
Low-power lasers are used in the early stages of the disease (i.e. during the first 10 to 20 days of the appearance of an anal fissure), whereas high-power lasers for fissure surgery through a sphincterotomy. Fissure laser surgery is performed under general anesthesia, local anesthesia, or spinal anesthesia. It is noteworthy that tissue carbonization should be prevented during fissure laser surgery.
What is fissure laser therapy?
Fissure laser therapy is a treatment option for acute cases in the early stages of the disease, not for chronic cases. Fissure laser therapy usually lasts 12 sessions and is performed two or three times a week. In fact, unlike fissure surgery with a high-power laser that is performed in a single session, fissure laser therapy is a longer treatment.
In some cases, laser therapy is combined with medication for treating acute anal fissures. The laser used in this procedure, i.e. infrared coagulation (IRC), does not cause wounds or bleeding.
What are the advantages of the anal fissure laser?
Patients who undergo fissure laser therapy or laser surgery experience no or negligible pain and bleeding. In addition, they can quickly return to their normal lives and workplaces after a very short recovery period. This also helps patients save more money. The risk of tissue swelling, scars, and fibrosis is very low in fissure laser surgery. This is an outpatient procedure performed in a single session without the need for anesthesia. If patients with an anal fissure also suffer from hemorrhoids or anal fistulas, all these decease can be treated simultaneously in a single session of laser surgery.
Some of the advantages of the anal fissure laser are as follows:
- The laser repairs the affected vessels, nerves, and lymph during the procedure, reducing the risk of pain and bleeding by up to 70% compared to conventional surgery (with blades and cauters).
- Unlike cauters and blades, laser equipment does not burn the tissue or cause severe pain and heavy bleeding.
- The superthin fiber laser makes more delicate incisions and does not damage the healthy tissue around the anal fissure, compared to blades and cauters,
- Because of the antiseptic properties of laser light, the risk of transmitting infections or other diseases is almost zero in fissure laser surgery.
In this image, you can see multiple anal fissures that have not responded to medications. This case can be treated by laser surgery in a single session
Post-fissure laser care
Patients undergoing fissure surgery or laser using the high-power CO2 laser need to rest at home for only one night. If the procedure is performed under spinal anesthesia, patients should avoid walking and keep their heads up during the first night. Patients may have a headache the next day if they do not rest sufficiently or use their mobile phones after spinal anesthesia. Note that you do not need to take antibiotics or special medications after the fissure laser, unless your physician prescribes you laxatives and painkillers. Patients are recommended to take a laxative the day after surgery in a way that they suffer from neither constipation nor diarrhea because both can damage the surgical site.
Take painkillers even if you do not have pain because the painkillers prescribed for you not only prevent pain but also reduce inflammation. You can sleep in any position after the fissure and hemorrhoid laser but be careful not to put pressure on the surgical site.
The surgical site is covered with a temporary dressing that should not get wet or infected. You can remove the dressing after 6 hours and take a bath the next day. It is recommended to sit in a basin of warm water with a few drops of betadine added for 10 minutes 3 times a day and allow the surgical site to be washed and disinfected thoroughly by opening and closing your anus. Note that should add only a few drops of betadine to the water in a way that the color of the water does not change. It is recommended to continue sitting in a basin of warm water for one week, even during menstruation.
If your surgeon prescribes an ointment, do not administer it using its applicator; such ointments are usually prescribed for external use after the fissure laser. It is quite normal to see a few drops of blood up to two months after the fissure laser. However, if you suffer from constipation or diarrhea and bleeding caused by abnormal defecation, it is better to visit your surgeon. You can also an ice compress to control bleeding.
If you have to take antibiotics and calcium or iron pills in the future, be sure to consume more vegetables and liquids and strictly prevent constipation and diarrhea. You need to visit your surgeon 3 and 10 days after the fissure laser. Make sure to visit your surgeon on time after the fissure laser, even if you notice no problem at the surgical site.
Patients who undergo conventional surgery or laser surgery for treating anal fissures, hemorrhoids, or other anorectal diseases should avoid fasting because fasting can cause dehydration and, thereby, constipation, which is a risk factor for the recurrence of such diseases.
It is recommended to avoid anal sex or sitting for a long time and also prevent chronic constipation and diarrhea after the fissure laser because all these items can cause the recurrence of this disease.
Frequently asked questions (FAQs) about the fissure laser
1-Is fissure laser a painful procedure?
Compared to conventional surgery, it can be stated that the fissure laser is not a painful procedure. The general surgeon and laser surgery specialist may use low-power or high-power lasers for treating your anal fissure. Regardless of the type of laser, this is an outpatient procedure that causes no pain or bleeding.
2-How much does the fissure laser cost?
The fissure laser cost depends on the stage of the disease and the place where this procedure is performed (e.g. a hospital, a clinic, or a doctor’s office). Although laser surgery is more expensive than conventional surgery using blades and cauters, its advantages, including a very short recovery period, save the patient’s time and cost after the treatment.
3-How to choose a clinic in Tehran for the fissure laser?
The experience and proficiency of the surgeon are of special importance in choosing a clinic for the fissure laser. It is better to visit a general surgeon and laser surgery specialist who is experienced in the surgical or laser treatment of anal fissures. The use of advanced methods and equipment and the satisfaction of previous patients are other criteria that can help you the best clinic in Tehran for the fissure laser. To get more information in this regard, please contact Dr. Saadati’s office at 0098 22761600.
4-What is the procedure for the fissure laser?
In fissure laser surgery, the general surgeon and laser surgery specialist make incisions in the affected sphincter with a high-power laser. Since the laser repairs the affected vessels and nerves at the same time, this procedure causes no wound or scar. In addition, a low-power laser is also used to facilitate the wound-healing process.
5-What is a laser fissurectomy?
In this method, the surgical incisions on the sphincter are made using a high-power laser instead of blades and cauters. This reduces the risk of postoperative complications such as anal incontinence.
6-Is the fissure laser a safe procedure?
Laser surgery requires high proficiency and special skills; if you visit an experienced general surgeon and laser surgery specialist, you can be sure that he/she performs the laser surgery quite safely. In addition, laser surgery is not associated with the risks and complications of the conventional surgery of an anal fissure.
7-How are pre-fissure laser examinations?
Patients with an anal fissure should not be examined internally because it can cause severe pain and exacerbate the disease. If necessary, the general surgeon performs internal examinations under appropriate anesthesia.