Successful Laser Internal Anal Sphincterotomy for Chronic Anal Fissure in a 31 Y.O. Male

PACE Hospitals’ expert Surgical Gastroenterology team successfully performed Laser Internal Anal Sphincterotomy with Skin Tag Excision on a 31-year-old male patient diagnosed with chronic anal fissure. The aim of the procedure was to relieve anal sphincter spasm, reduce long-standing pain during defecation, promote fissure healing, remove the associated skin tag, improve bowel comfort, and prevent recurrence.

A 31-year-old male patient with a body mass index (BMI) of 20 presented to the Surgical Gastroenterology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of pain during defecation for the past 2 years. Initially, the pain responded to conservative treatment, but symptoms recurred, with increased severity over the last 2 months.

The patient had a history of constipation, which was associated with recurrent fissure symptoms. There was no history of bleeding per rectum and no history of previous anorectal surgeries.

On examination, the patient was conscious, coherent, and well oriented, with stable vital signs. General physical examination revealed a stable condition. Vital parameters were within normal limits, and there were no acute cardiorespiratory abnormalities detected.

Upon admission to PACE Hospitals, the Surgical Gastroenterology team conducted a comprehensive evaluation based on the patient's history of chronic pain during defecation. A detailed medical history, clinical examination, and preoperative assessment were performed to determine the severity of symptoms and assess fitness for surgical intervention.

The patient reported recurrent symptoms for nearly 2 years, with worsening pain over the preceding 2 months despite conservative treatment. Clinical evaluation revealed a chronic anal fissure located at the 6 o’clock position, associated with a skin tag and a history of constipation.

Based on the confirmed diagnosis, the patient was advised to undergo a Chronic Anal Fissure Treatment in Hyderabad, India, under the expert care of the Surgical Gastroenterology Department.

After a detailed consultation with Dr. CH Madhusudan (Senior Consultant Surgical Gastroenterologist and Liver Transplant Surgeon), along with the team, including Dr. Suresh Kumar S (Consultant Surgical Gastroenterologist), a comprehensive evaluation was carried out considering the patient's history of chronic pain during defecation for 2 years, recurrent symptoms despite conservative treatment, worsening pain over the preceding 2 months, and associated constipation. Clinical assessment confirmed the presence of a chronic fissure in Ano at the 6 o’clock position with an associated skin tag.

Based on the clinical presentation, failure of conservative management, and examination findings, it was determined that Laser Internal Anal Sphincterotomy with Skin Tag Excision was the most appropriate therapeutic intervention. The procedure was planned to relieve internal anal sphincter spasm, reduce pain during defecation, promote fissure healing, remove the associated skin tag, and minimize the risk of recurrence.

The patient and family members were counselled regarding the diagnosis, proposed surgical procedure, expected benefits, possible risks, and postoperative care.

Following the decision, the patient was scheduled to undergo Laser Internal Anal Sphincterotomy with Skin Tag Excision Surgery in Hyderabad at PACE Hospitals, under the expert care of the Surgical Gastroenterology Department.

The procedure involved the following steps:

• Patient Preparation and Anaesthesia: The patient was taken to the operating room after obtaining informed consent and completing pre-anaesthetic evaluation. Under appropriate anaesthesia, the patient was positioned to allow adequate exposure of the perianal region. Standard aseptic precautions were followed throughout the procedure.
• Examination and Fissure Identification: A careful perianal examination was performed. A chronic anal fissure was identified at the posterior midline in the 6 o’clock position, along with an associated skin tag.
• Laser Internal Anal Sphincterotomy: Laser internal anal sphincterotomy was performed to carefully release part of the internal anal sphincter. This helped reduce sphincter spasm, lower anal canal pressure, and support healing of the chronic fissure.
• Skin Tag Excision: The associated skin tag was excised carefully using appropriate surgical technique. Hemostasis was achieved to prevent bleeding, and the operative area was inspected for any active bleeding or complications.
• Final Check and Completion: The surgical site was cleaned and checked thoroughly. The patient was shifted to the recovery area for postoperative monitoring and further care.

The procedure was uneventful, and postoperative recovery was satisfactory. The patient was monitored for pain, bleeding, bowel comfort, and overall clinical stability. He remained hemodynamically stable and was discharged with postoperative care instructions and follow-up advice.

The patient was discharged with medications prescribed for postoperative infection prevention, pain relief, gastric protection, and bowel softening to avoid straining during defecation. Supportive bowel-regulating medications were also advised to ensure smooth and comfortable stool passage.

The patient was advised to continue previous medications, if any, and follow a normal diet. Blood sugar monitoring at home was advised, including fasting and post-lunch blood sugar levels. Sitz bath with 5% topical antiseptic twice daily for 5 days was recommended to promote local hygiene, reduce discomfort, and support healing.

The patient was instructed to contact the emergency ward at PACE Hospitals in case of fever, abdominal pain, vomiting, worsening pain, bleeding, or any other emergency symptoms.

The patient was advised to return for a follow-up visit with the Surgical Gastroenterologist in Hyderabad at PACE Hospitals, after 5 days to review his condition, along with fasting blood sugar, postprandial blood sugar, and HbA1c reports.

This case highlights a chronic anal fissure managed successfully with laser internal anal sphincterotomy and skin tag excision. The procedure was uneventful, and the postoperative recovery was satisfactory. The patient was discharged in a hemodynamically stable condition with advice on sitz bath, bowel regulation, blood sugar monitoring, and regular follow-up for further evaluation.