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Dr. Andrew Rynne

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Is laser hemorrhoidoplasty procedure an effective treatment for anal fissure?

Answered by
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 1920 Questions

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Posted on Tue, 24 Apr 2018 in Digestion and Bowels
Question: I have been diagnosed with anal fissure in XXXXXXX 2017. I have had pain on and off since XXXXXXX 2017. At that time the pain was not too severe or persistent and went away after applying proctosedyl cream for a few weeks. It returned in XXXXXXX 2017 after persistent constipation and hard stools. I had severe constipation and hard stools even in XXXXXXX 2017 and again in May-June 2017. Since July 2017, I am taking herbal laxative and applying herbal cream to the fissure. The fissure seems to have healed to a great extent. I do not experience regular pain any more. The medicine was prescribed by a surgeon who I consulted with. Modern medicine was not prescribed. As per him the diagnosis is that the fissure has healed as of now. The anal cavity has contracted by 33%. Hence to get permanent relief, I should undergo Laser Haemmorrhoidoplasty. I don't understand why I should undergo the prescribed surgery when I do not have haemorrhoids. I thought fissures are treated by performing Lateral sphincterotomy. Please explain whether LHP will be an effective treatment for fissures.
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Video-assisted anal fistula treatment (VAAFT) is for you.

Detailed Answer:
Hi,
Thanks for asking on HealthcareMagic.

I have gone through your query carefully.

Hemorrhoidoplasty has nothing to do with fissures.

Operation of choice for you is Video-assisted anal fistula treatment (VAAFT). It is a novel minimally invasive and sphincter-saving technique for treating complex fistulas.

The main feature of the VAAFT technique is that the procedure is performed entirely under direct endoluminal vision. With this approach, the internal opening can be found in 82.6% of cases.

Moreover, as fistuloscopy has already identified a possible secondary tract its easy to close them. The VAAFT technique is sphincter-saving, and the surgical wounds are extremely small.

Hemorrhidoplasty has no role in your case.

Hope I was helpful. Feel free to ask further.
Regards!



Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Ramesh Kumar 9 hours later
Can you please explain how the suggesed surgery will help in the case of fissure? Most of the explanation in your answer pertains to how it benefits fistula cases.
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Both have same surgical treatment.

Detailed Answer:
Hi again dear,
Anal fissure is a tear while anal fistula is a tract formed upto anal canal if tear is left untreated.Whether its just a fissure or fistula depends on report of CT or MRI.However Surgical procedure for both of them are same so for cost cutting some doctors don’t go for a CT or MRI.
Please attach reports of-
1)CT- Fistulogram is a easy test to find the course of fistula.A radioactive XXXXXXX is injected and Scans are taken by CT machine,Track of fistula/Fissure can easily be seen in this procedure.

2)MRI is the method of choice for evaluating perianal fistulae/fissure due to its ability to display the anatomy of the muscles , with high resolution contrast.
Without these tests how your doctor knows if its fissure or fistulae?

Why did your gastroenterologist suggested you for hemorrhoidoplasty?I want to read his explaination.

Please attach reports of these tests so that i can guide you further.
Waiting!



Above answer was peer-reviewed by : Dr. Vaishalee Punj
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