Fissure Surgery in Delhi

Fissure surgery is a procedure performed to treat an anal fissure, which is a small tear in the lining of the anus. Usually, surgery is required when conservative treatments such as dietary changes, medications, and topical ointments fail to provide relief. The most common approach is lateral internal sphincterotomy, where a small part of the anal sphincter muscle is divided to reduce spasm, ease pain, and allow the fissure to heal effectively. This short procedure is generally safe, offers long-term relief, and helps restore comfort in daily life.

Anal fissures can vary in severity, from acute cases that respond to simple measures to chronic fissures that require surgical correction. Depending on the extent of the tear, associated symptoms, and the patient’s overall health, different surgical approaches are considered to provide effective and lasting relief.

Lateral Internal Sphincterotomy (LIS)

This is one of the most commonly performed surgeries for chronic anal fissures. It involves making a small cut in the internal anal sphincter muscle to reduce tension, improve blood flow, and promote healing. LIS has a high success rate and provides long-term relief from pain.

Fissurectomy

In this procedure, the surgeon removes the fissure and surrounding scar tissue to allow the area to heal naturally. It is often combined with sphincterotomy for better outcomes.

Botox Injection (Minimally Invasive Option)

In selected cases, botulinum toxin (Botox) is injected into the anal sphincter muscle to temporarily relax it, reduce spasm, and support healing of the fissure. This is considered a less invasive alternative for patients not suitable for surgery.

Advancement Flap Surgery (for Complex Fissures)

For fissures that do not heal with standard methods, a healthy tissue flap (from nearby skin or rectal lining) is advanced to cover the fissure, improving blood supply and aiding recovery.

At Max Hospitals, our surgeons carefully evaluate each patient’s condition before recommending the most suitable surgical technique, ensuring safe, effective, and long-lasting relief.

While fissure surgery is generally safe and highly effective, it's important to be aware of potential risks, just as with any surgical procedure. The risks can be grouped into immediate, short-term, and long-term concerns.

Immediate and Short-Term Risks (During and right after surgery)

• Pain and Discomfort: It is normal to experience some pain and discomfort at the surgical site. This is typically managed with prescribed pain medication.
• Bleeding: Minor bleeding or spotting is common for a few days after the procedure, especially during bowel movements. However, excessive or heavy bleeding is rare and should be reported to your doctor immediately.
• Swelling and Bruising: Temporary swelling and bruising around the surgical area are common and will gradually go away as you heal.
• Infection: While rare, there is a small risk of infection at the surgical site. Signs of infection include increased redness, warmth, swelling, or a fever. Following post-operative care instructions is crucial to minimize this risk.
• Difficulty Urinating: Some people may temporarily have trouble urinating after the surgery due to swelling or the effects of anesthesia. This usually resolves on its own.
• Difficulty with Bowel Movements: The fear of pain during a bowel movement can sometimes lead to constipation. It's important to follow your doctor's advice on diet and stool softeners to keep stools soft and easy to pass.

Long-Term Risks 

• Incontinence: This is one of the most significant concerns for patients considering fissure surgery, particularly for Lateral Internal Sphincterotomy (LIS). It involves the potential for a temporary or, in very rare cases, permanent loss of control over passing gas or stool. Most cases of incontinence are minor and temporary, improving as the body heals and the muscles adjust.
• Recurrence: Although surgery has a high success rate, there is a small chance that the fissure can return, especially if the underlying causes like chronic constipation or straining are not addressed.
• Non-Healing or Persistent Pain: In some cases, the wound may heal slowly, or a patient may experience persistent pain, requiring further evaluation or management.
• Fistula Formation: In rare cases, a chronic non-healing wound can lead to the formation of a fistula, which is a small tunnel or channel that develops between the inside of the anal canal and the skin. This typically requires a separate, minor surgery to correct.

Understanding what to expect at each stage of fissure surgery helps patients feel more prepared and confident about the process. The journey typically involves three key phases — preparation before the procedure, the day of surgery itself, and post-operative recovery. Each phase is designed to ensure safety, comfort, and the best possible outcome.

Pre-Operative Preparation

Preparation is key to a smooth and successful surgical journey. While the process may seem daunting, a few important steps can make a significant difference. Here are the essential preparations to ensure a safe procedure and the best possible outcome.

• Medical evaluation: A comprehensive medical assessment is usually conducted to ensure overall fitness for surgery. This may include a physical examination, blood tests, and a review of current health conditions or medications.
• Medication adjustments: Certain medicines, such as blood thinners, may need to be stopped or adjusted in consultation with the doctor to minimise the risk of bleeding during surgery.
• Lifestyle modifications: Avoidance of smoking and alcohol consumption is recommended in the weeks leading up to surgery, as both can affect healing and increase surgical risks. To help prevent constipation, your doctor may also advise increasing fiber and water intake before the procedure.
• Pre-surgery instructions: Detailed guidance is provided, which may include fasting before the procedure, arranging for post-surgery support, and preparing the home environment for a comfortable recovery.

On the Day of the Procedure

Fissure surgery is usually performed as a day-care procedure under anaesthesia. The process typically includes the following steps.

• Hospital admission: Patients are admitted to the hospital or surgical facility where final checks are performed to confirm readiness for surgery.
• Anaesthesia administration: Depending on the case, local anaesthesia with sedation, a regional block (like a spinal), or general anaesthesia is administered to ensure comfort during the procedure.
• Surgical process: The surgeon makes a small incision to partially cut the internal anal sphincter muscle, which helps to relieve muscle spasm and allows the fissure to heal. This procedure is called a lateral internal sphincterotomy.
• Completion and observation: Once the surgery is complete, the patient is then monitored in a recovery room for a short duration before being discharged on the same or next day in most cases.

Recovery from fissure surgery is gradual, with most individuals resuming normal activities within a couple of days. The recovery phase after fissure surgery typically includes the following important aspects.

• Immediate care: Warm baths (sitz baths) may be advised to reduce discomfort and promote healing. Prescribed pain medication and stool softeners may be used as directed.
• Pain management: Mild discomfort and soreness are expected for a few days and can usually be managed with prescribed pain relievers.
• Activity restrictions: Strenuous activities, heavy lifting, and any activities that cause strain should be avoided for at least one to two weeks to allow proper healing.
• Follow-up visits: Regular follow-up appointments are scheduled to monitor recovery and ensure the surgical site is healing well.
• Long-term outcome: While initial pain relief is often immediate, final healing of the fissure may take a few weeks. The long-term outcome is generally excellent, with a very high success rate for relieving pain and preventing recurrence.

Max Hospitals is among India’s most trusted centres for colorectal and gastrointestinal care, offering advanced treatment for anal fissures with a strong focus on safety and long-term results. Patients and their families choose us for the following reasons:

• Expert Colorectal Surgeons: Our highly skilled specialists have extensive experience in performing fissure surgeries, including lateral internal sphincterotomy and advanced techniques for complex cases.
• Modern, Minimally Invasive Techniques: We use the latest surgical methods to ensure smaller incisions, reduced pain, faster healing, and minimal downtime.
• Comprehensive Pre- and Post-Surgery Care: From initial consultation to full recovery, our multidisciplinary team provides continuous guidance and support tailored to each patient’s needs.
• Internationally Benchmarked Safety Protocols: All procedures are conducted in NABH-accredited facilities, with strict infection control measures and advanced anaesthesia care.
• State-of-the-Art Infrastructure: Equipped with modern operation theatres, precision instruments, and advanced monitoring systems, we ensure safe and effective outcomes.
• Patient-Centred Approach: Beyond treating the fissure, we address the patient’s overall well-being, providing counselling, lifestyle advice, and long-term follow-up care.

When is surgery recommended for an anal fissure? 

Surgery is typically recommended for chronic anal fissures that have not healed after several weeks of trying non-surgical treatments like dietary changes, fibre supplements, and topical ointments. ⁠At times, surgery is also done in acutely painful fissure, as surgery provides almost immediate relief of symptoms.

Is fissure surgery painful? 

The surgery is performed under anaesthesia, so you won't feel any pain during the procedure. After surgery, you may have some discomfort, which is managed with prescribed pain medication.

How long does it take to recover from fissure surgery? 

Most patients feel significantly better within a few days. You can usually return to light, non-strenuous activities within a week, but full recovery, including resuming strenuous exercise, may take 4 to 6 weeks.

How do I prepare for fissure surgery? 

You will be given specific instructions, but generally, you will need to stop taking certain medications like blood thinners, avoid alcohol and smoking, and fast for a specific period before the surgery. You should also arrange for transportation and help at home for the first couple of days.

Will I have a scar after the surgery? 

The incision for a lateral internal sphincterotomy is very small and is typically placed in an area that is not highly visible. Any scarring is minimal and will fade over time.

Can I sit comfortably after the surgery? 

Yes, you should be able to sit. Using a soft cushion or a doughnut-shaped pillow can help relieve pressure and increase comfort during the first few days of recovery.

Do I need to stay overnight in the hospital? 

Usually the patient is kept in hospital for a night for observation but depending upon the individual's recovery, they may be discharged on the same day as well. Fissure surgery is a day-care procedure. This means you will be discharged on the same day after a short period of observation in the recovery room.

What should I eat after the surgery? 

Your doctor will provide dietary advice, but the focus will be on a high-fibre diet and drinking plenty of water to prevent constipation and ensure soft bowel movements, which is crucial for healing.

Will fissure surgery affect my ability to control my bowels? 

The risk of permanent incontinence is extremely low. The goal of the surgery is to carefully and partially cut the muscle, which relaxes it without compromising your ability to control bowel movements.

What is the difference between an acute and a chronic anal fissure? 

An acute fissure is a recent tear that usually heals within a few weeks with conservative treatment. A chronic fissure is one that has lasted for six weeks or longer and often requires surgical intervention.

How much does fissure surgery cost? 

The cost of fissure surgery can vary based on the specific surgical technique used, the surgeon's fee, and hospital charges. A clear cost estimate will be provided after your initial consultation.

Can I exercise after fissure surgery? 

You should avoid heavy lifting and strenuous exercise for at least 1 to 2 weeks or as advised by your surgeon to prevent straining and allow the surgical site to heal properly. You can resume gentle activities like walking much sooner.

Reviewed by Dr. Rahul Singh, Associate Director & Unit Head – Minimal Access, Hernia & Metabolic Bariatric Surgery, General Surgery, Laparoscopic / Minimal Access Surgery on 24 November 2025.