CO2 Laser Therapy for Chronic Anal Fissure Resistant to Non-Invasive Treatment: A Single Centre Experience

Abstract

Background: The treatment of chronic anal fissure is predominantly conservative. However, failure of conservative measuresobliges the use of more potent treatments, such as Botulinum Toxin (BT) injections to relax the internal anal sphincter. Furthermore, surgical intervention represented by lateral internal sphincterotomy (LIS) is used to treat resistant cases but imposes the risk of faecal incontinence. The aim of our study is to assess the degree of post-operative pain, recovery time and the rate of postoperative faecal incontinence in patients where CO2 laser is used to perform LIS.Methods: 236 patients clinically diagnosed with chronic anal fissure through 2012-2014 were included in the study. The selected patients were those who did not benefit from conservative treatment. The approach we took starts with Examination Under Anaesthesia (EUA), followed by excision of the fibrotic anal fissure using CO2 laser on continuous mode with defocus technique for haemostasis. Wound healing was induced by secondary intention. The follow-up period extended for 2 years postoperatively.Results: The effectiveness of laser LIS was tested over two domains, pain score and post-operative complications. On a pain scale of 1-10, all patients had a pain score of one or less on day seven. Three patients (1.27%) hadrecurrent pain and bleeding within two years and were treated conservatively. No patients had incontinence at the last follow-up. Six patients (2.5%) developed minimal mucus discharge for three months post operatively.Conclusion: The treatment of resistant chronic anal fissure with CO2 laser shows promising outcomes when compared to conventional LIS. Laser surgery offers the advantage of being a minimal surgical intervention in addition to a reduced risk of incontinence and recurrence when compared to other methods such as BT injections and conventional LIS