Fissurectomy with anoplasty (advancement flap)

Great hope followed by devastation (fistula)

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Fissurectomy with anoplasty (advancement flap)

Postby ttt2018 » 14 Jul 2019, 10:14

In case it can help, I am writing about my fissurectomy with anoplasty surgery (aka advancement flap procedure). It is a more conservative procedure since it does not involve cutting the sphincter. It seems promising, but I got extremely unlucky with the development of an abscess and fistula.

Background: My chronic fissure came back after a few years of dormancy. Initial treatment of the noninfected fissure with metronidazole suppositories was extremely effective for pain relief and wound healing. However, since it was chronic, the scar kept reopening every 3-4 weeks (each time for 1 week to 10 days). Since I had already dealt with a constantly recurring fissure years before, I decided to break the cycle at 6 months, even though I was not in great pain after the initial bout. I had always feared LIS and would never have done it in my condition, due to the risks. However, where I live, LIS is now a quite rare procedure, replaced by the sphincter-sparing fissurectomy with anoplasty. Since this did not involve snipping the sphincter, I was very hopeful this more conservative treatment would finally end the cycle. Like many others, I developed severe anxiety and panic attacks related to the condition (first time in my life), which contributed to my decision to get the operation.

I had the surgery in November 2018. The first two weeks were very painful and isolating, although I must admit the first poo post-surgery was not as excruciating as I'd feared. Had dramatic improvement in pain relief at week 2 post-op, then essentially was pain-free at week 3.

However, the wound healed irregularly, creating a sort of pocket/bridge of skin. At month 3 an infection developed in this pocket - this is one of the main risks of this type of surgery. The infection created a small abscess which then burst, creating a tiny fistula.

Now with a small fistula, I had no choice but to get a fistulectomy/fistulotomy. This involved cutting the sphincter: everything I'd always feared. I was devastated but after 5 opinions realized that it was the only option. This surgery occurred in March 2019. Dramatic pain relief after day 3, and pain-free within a week or two. Full wound healing at about month 3.

I'm now 4 months after the fistulectomy (8 months post-anoplasty). The "good" news is that the fissure itself is cleared up for now, although it may come back of course; despite the second surgery, I was assured that I was still in a better position than prior to the first surgery in terms of the AF. The other "good" news was that the second surgery, to cut open the irregular wound pocket, corrected some awful stool leakage problems that were clearly related to that. Now at 4 months it is hard for me to gauge my full level of healing, or if I will have some minor long-term issues; much of this is probably psychological.

I still believe the sphincter-sparing procedure is preferable to LIS, despite my experience. Any anal surgery carries the risk of infection (and thus abscess/fistula as well). I was told it was less than 5% of cases with anoplasty. I got terribly unlucky and now am filled with predictable second thoughts. Should I have waited? Should I have lived with the fissure? Could I have possibly gotten to a place of acceptance with the AF or would I have regretted not getting the surgery? The anal fissure presents you with a cruelly impossible choice.
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Re: Fissurectomy with anoplasty (advancement flap)

Postby North West Jen » 15 Jan 2020, 23:49

Boy, doesn’t it ever! I’m happy to hear you are healing and in a better position post surgery.
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