Controlled laser sphincterotomy for anal fissure

AIM: to evaluate original method to relieve spasm of the sphincter for surgery of chronic anal fissure.

PATIENTS AND METHODS: sixty-six patients with chronic anal fissure with spasm were included in the pilot study. These patients underwent controlled laser sphincterotomy of the internal sphincter with bare tip fiber laser surgery unit IPG “IRE-Polus” with a wavelength of 1.56 µm affecting the whole internal sphincter circumference with the overall energy impact in average 300–400 J. The second stage of treatment was standard fissure excision in the longitudinal direction with further suturing of the wound in the same direction. In the end, 1.5–2 ml of plateletrich plasma was injected under the sutured wound. Before and 1 month after the surgery all the patients underwent sphincterometry.

RESULTS: all the patients showed increased anal sphincter tone before surgery. After the use of the original method, the sphincter tone of 63 patients (95.5%) has returned to normal, no pain syndrome developed. Since the spasm still took place in 3 cases (4.5%), controlled laser sphincterotomy was used within few days after surgical treatment, and as a result the spasm was adequately removed. In 2 (3.0%) cases transient gases incontinence was noted, which disappeared by itself within one month after operation. Thirteen (19.7%) patients had complications, not connected to the controlled laser sphincterotomy. In 9 cases complications were connected with suturing of the wound (ligature fistula and wound dehiscence.) In 4 cases long-term non-healing wounds were revealed, complete healing in these cases took 104.0 days. The complete healing of 62 patients, not taking into account these 4 cases with long-term non-healing wounds was 29.6 days.

CONCLUSION: the original method is safe, quite effective, and the digital value of energy which affects sphincter makes it possible to control it. The further study is needed.

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