Laser Fissurectomy Combined with Limited Lateral Internal Sphincterotomy for Chronic Anal Fissure: A Minimally Invasive Technique.

Abstract

Chronic anal fissure (CAF) is a common benign anorectal condition characterised by severe pain and internal anal sphincter (IAS) hypertonia. Although lateral internal sphincterotomy (LIS) remains the surgical gold standard, the risk of postoperative faecal incontinence remains a clinically significant concern. We describe a minimally invasive hybrid technique combining 1470-nm diode laser fissurectomy with a limited closed LIS. The laser ablates the chronic ulcer triad whilst a tailored sphincterotomy confined to the distal one-third of the IAS addresses the underlying hypertonia. Based on published series of comparable sphincterotomy techniques, this approach is designed to target healing rates of 93-97 %, comparable to traditional LIS, with significantly reduced postoperative pain and a substantially lower risk of faecal incontinence through sphincter-sparing design. These figures represent literature-derived benchmarks that the technique is designed to achieve, rather than outcomes from a formal patient cohort reported in this article. Laser fissurectomy combined with limited closed LIS is a reproducible, day case technique conceptually designed to balance high healing rates with preservation of anorectal function, pending formal prospective validation. It is suitable for adoption in any coloproctological unit equipped with 1470-nm diode laser technology.