What is Laser Fissure Surgery?

Laser Fissure Surgery is an advanced surgical procedure to treat anal fissures. In this procedure, a laser beam destroys the scarred tissue area. Being a quick procedure, it is generally performed in an outpatient setting, meaning the patient can leave on the same day of the surgery.

Anal fissures are linear tears or open sores in the anus opening caused due to trauma or an injury. An anal fissure also causes pain, itching, and bleeding.

Anatomy and Physiology of Anal Region

The anal region, also known as the anorectal region, is a complex body area that includes structures involved in defecation (passing stool) and maintaining continence (control over bowel movements).

Here's an overview of the anatomy of the anal region:

1. Anus: The anus is the external opening of the digestive tract through which stool (faeces) is eliminated from the body.
   It is surrounded by muscles that help release stool and maintain continence.
2. Anal Canal: The anal canal is a short passage that extends from the anus to the rectum.
   It is lined with a mucous membrane and is where anal fissures and haemorrhoids can develop. Two muscular sphincters surround the anal canal:
   Internal Anal Sphincter: This involuntary smooth muscle sphincter is inside the anus and remains contracted to maintain continence. It relaxes during defecation.
   External Anal Sphincter: Voluntary skeletal muscles that surround the internal sphincter and can be consciously controlled to maintain continence.
3. Rectum: The rectum is the last part of the large intestine (colon) and serves as a temporary storage area for stool before they are expelled from the body.
   The rectum stretches as stool accumulates, triggering the sensation of needing to defecate.
4. Anal Sinuses: The anal canal contains small pockets called anal sinuses and crypts, which can become irritated or infected, leading to conditions like anal fistulas or abscesses.
5. Hemorrhoidal Tissue: Haemorrhoids are clusters of blood vessels, connective tissue, and muscle located near the anus and inside the rectum.
   They play a role in maintaining continence and can become swollen or inflamed, causing discomfort.
6. Perianal Skin: The skin around the anus is called the perianal skin. It is sensitive and prone to itching, rashes, and infections.

Conditions Treated With Gastric Bypass Surgery

Gastric bypass surgery makes long-term alterations to the metabolic system of an individual. This leads to the improvement of several obesity-related conditions. Some of the primary issues treated include:

1. Type 2 diabetes
2. Heart disease
3. Hyperlipidemia (high cholesterol)
4. Sleep apnoea (breathing repeatedly stops and starts during sleep)
5. Osteoarthritis

Who Needs Laser Fissure Surgery?

Laser fissure surgery, also known as laser fissurectomy, is a potential treatment option for individuals with chronic anal fissures that have not responded to conservative treatments.

Generally, chronic anal fissures are treated with the help of laser fissure surgery. In addition to anal fissures, the following conditions are also treated with laser surgery.

1. Piles or Haemorrhoids
2. Anal fistula
3. Pilonidal sinus

Laser fissure surgery might be recommended for individuals who:

1. Have Chronic Fissures: If an individual has experienced anal fissures for an extended period and the condition hasn't improved with lifestyle changes, dietary adjustments, and other conservative treatments, the doctor might consider surgical options.
2. Experience Severe Pain: Fissures can be extremely painful, particularly during bowel movements.
   If the pain is severe and affects the quality of life, laser fissure surgery might be an option.
3. Bleeding Persists: If your fissures are causing persistent bleeding, your doctor might suggest surgical treatment to promote healing and reduce bleeding.
4. Desire Quicker Healing: Laser fissure surgery is generally considered a minimally invasive option that can promote quicker healing compared to traditional surgical methods.
5. Wish to Avoid Traditional Surgery: Some individuals might prefer minimally invasive techniques like laser surgery over traditional surgical procedures.
   This is because they may offer advantages such as less pain, shorter recovery time, and reduced risk of complications.
6. Find Conservative Treatments Ineffective: Before surgery is considered, doctors typically recommend conservative treatments such as warm baths, stool softeners, increased fibre intake, and topical medications.
   If these approaches don't provide relief, surgery could be an alternative.

Benefits of Laser Fissure Surgery

Laser sphincterotomy offers several potential benefits for individuals suffering from chronic anal fissures that have not responded to conservative treatments.

While the specific advantages can vary depending on individual circumstances, here are some potential benefits of laser fissure surgery:

1. Minimally Invasive: Laser fissure surgery is considered a minimally invasive procedure.
   It involves using a laser to precisely target and remove the damaged tissue, often requiring smaller incisions than traditional open surgical techniques.
2. Reduced Pain and Discomfort: The focused laser energy can help promote healing and reduce muscle spasms around the anal sphincter.
   This leads to decreased pain and discomfort during bowel movements and in daily activities.
3. Faster Healing: Laser technology can help stimulate tissue regeneration and enhance blood flow to the affected area, potentially leading to quicker healing than conventional surgical methods.
4. Less Bleeding: The laser can cauterise blood vessels as it cuts, reducing bleeding during the procedure and potentially in the post-operative period.
5. Shorter Recovery Time: Due to the minimally invasive nature of laser fissure surgery, patients may experience a shorter recovery period than traditional open surgeries.
6. Reduced Risk of Infection: Laser technologys precision can help minimise tissue damage and reduce the risk of infection at the surgical site.
7. Improved Quality of Life: By addressing chronic anal fissures and their associated symptoms, laser fissure surgery can improve quality of life, reducing pain, discomfort, and disruption to daily activities.

What to Expect Before and on the Day of Laser Fissure Surgery?

Before and on the day of laser fissure surgery, there are several important steps and preparations to be aware of. Heres what you can generally expect:

1. Doctor Consultation: A consultation with the surgeon is held before the scheduled surgery date.
   During this appointment, the patients medical history, current symptoms, and previous treatments are discussed for the anal fissure.
2. Physical Examination: The surgeon will perform a physical examination of the anal area to assess the severity of the fissure and determine whether laser fissure surgery is an appropriate treatment option.
3. Medical Tests: Depending on the patients medical history and overall health, the surgeon may order specific medical tests, such as blood tests or imaging studies, to ensure a good condition for surgery.
4. Preoperative Instructions: Detailed preoperative instructions from the surgeon or medical team are provided.
   These instructions might include guidelines for fasting before the surgery, what medications to take or avoid, and how to prepare for the surgery day.

On the Day of Intragastric Ballooning Procedure

1. The patients consent may be taken after informing them about the risks and benefits of the procedure.
2. The doctor may prescribe an antacid to prevent acid reflux during the procedure.
3. A liquid diet may be advised in an attempt to empty the stomach for the procedure.
4. The patient may be asked to fast a night prior to the procedure.

How is Laser Fissure Surgery Performed?

Laser fissure surgery is a minimally invasive procedure which usually takes about 15 to 30 minutes to complete depending on the patients age, other medical conditions of the patient and the severity of the condition.

This procedure is performed using a CO2 laser or 1470 nm diode laser to treat anal fissures under the influence of local or general anaesthesia. The laser beams destroy the scarred tissue area.

The following steps are carried out during the procedure:

1. Anaesthesia: Before the procedure begins, the patient will be given anaesthesia to ensure that they are comfortable and pain-free during the surgery.
   Depending on the case, local anaesthesia, regional anaesthesia (such as a spinal block), or general anaesthesia may be administered.
2. Preparation: Once the patient is anaesthetised, the surgical area will be cleaned and prepped for the procedure.
3. Laser Application: A specialised surgical laser is used to precisely target the tissue around the fissure and sealing of blood vessels to minimise bleeding.
   The laser can be used to remove any scar tissue or damaged tissue that is contributing to the fissure.
4. Wound Care: After the laser treatment, the surgeon may apply a bandage with medication to the surgical site to aid in healing and prevent infection.
5. Closure and Recovery: Unlike traditional surgical methods that involve cutting and suturing, laser fissure surgery typically does not require sutures.
   The area will be left to heal naturally, and the wound will close on its own over time. The patient will be monitored in a recovery room until the effects of the anaesthesia wear off and stability is regained to go home.

Cost of Intragastric Ballooning Procedure

The estimated cost of placing an intragastric balloon is ₹1,50,000 to ₹3,50,000. It can vary depending on multiple factors such as:

1. The consultation fee
2. Diagnostic exams for intragastric ballooning risks and recovery
3. Admission fee
4. The patients existing medical condition
5. Age of the patient
6. Type of hospital chosen for the procedure
7. The type of room chosen for the recovery period
8. The city where the hospital is located

Takeaway

Laser fissure surgery stands out as a minimally invasive and precise approach to treating anal fissures. The focused laser energy not only accelerates healing but also reduces post-operative discomfort.

Moreover, the reduced risk of complications, minimal scarring, and personalised treatment adjustments make laser fissure surgery an appealing option.