High-Intensity Laser Therapy - An Option for Managing the Pain in Anal Fissures.

Abstract

Introduction: Anal fissures (AFs) are a prevalent pathology. Although internal lateral sphincterotomy is still the gold-standard surgery for treating chronic AFs, this procedure is associated with a considerable risk of anal incontinence. This study describes an alternative and minimally invasive technique for treating AFs using photobiomodulation and a high-power diode laser-fissure treatment (LFT) and highlights initial results pertaining to pain. Methods: This retrospective study focused on 38 patients treated with LFT on an outpatient basis at three different hospitals in different states of Brazil (Santa Catarina, Paraná, and São Paulo). The objective was to evaluate the effects of LFT treatment on AF patient pain following the procedure. The Friedman test was used to identify the effects of LFT treatment over time (D0, D7, D15, D30, and D60) on postoperative pain intensity using the visual analogue scale (VAS). Complications and incontinence rates were also analyzed. Results: Roughly two-thirds of the patients (66%; n=25) were male. The median age of the cohort was 49. Constipation was described by 32% of the patients, 13% were smokers, and 21% had recently used opioids. In 92% of the cases, the AF was localized posteriorly. Skin tags were present in 27% of the cases, and 26% had recently undergone a previous orificial surgery. A significant reduction in pain was observed over time in the intensity of postoperative pain measured by the VAS. Prior to surgery (D0), the patients' mean VAS score was 4.1; it progressively decreased to 0.1 on the 60^th postoperative day (P<0.05). There was no significant change in fecal continence at the end of the 60-day follow-up period. Minor complications occurred in 7.9% of the patients (2.6% hemorrhoidal thrombosis, 2.6% skin tag, and 2.6% "failure"). Conclusion: Our results suggest that treating AFs with laser therapy results in a significant reduction in pain intensity over time without interfering with anal continence.