Prof. Sunder Goyal, MS, Professor and HOU
Dept. of Surgery, ESIC Medical College & Hospital, Faridabad, India
Fissure-in-ano is a common condition characterized by a tear in anal mucosa around the anal verge. Acute fissures are usually managed conservatively by local application of ointments, Sitz bath, and stool softeners while chronic fissures mostly require surgical management due to associated spasm of the internal sphincter which plays an important pathophysiological role. Increased anal sphincter tone is associated with decreased vascular supply and thus impaired wound healing to the area of anal fissure.
Surgical management of chronic anal fissure is based on relieving the sphincter spasm by performing sphincterotomy which can be done via open or closed methods. We postulated that using radiofrequency ablation for performing sphincterotomy will have certain advantages over conventional methods due to minimal lateral heat dissipation and improved management of associated pathology like sentinel tags.
We performed RF assisted sphincterotomy for chronic anal fissure as a pilot project in 5 patients. Patients were placed in lithotomy position under regional anesthesia. Under all aseptic precautions, Lord’s dilatation was done initially followed by a proctoscopic examination. Intersphincteric groove was identified by manual palpation and RFA probe (HPR45i probe, F-care systems, Belgium) was introduced in the intersphincteric space at 3 ‘0 clock position. Internal sphincter was ablated using approximately 1200J energy. Fissure surface was also ablated using same probe to promote healing. Post-operative period of these patients was uneventful with next day discharge to home. Patients were followed up for 2 months with complete healing of the fissure taking 4 to 6 weeks.
Radiofrequency Ablation (RFA) is a potential treatment for Chronic Fissure-in-ano and further randomized controlled trials are necessary to investigate the benefits of radiofrequency as compared to conventional surgery for anal fissure.