TREATMENT OF ANAL FISSURE WITH LASER – A MINIMALLY INVASIVE OPTION FOR PAIN MANAGEMENT IN ANAL FISSURES? A BRAZILIAN MULTICENTER STUDY

Introduction Anal fissure (AF) is a common condition in proctologists' offices. Although internal lateral sphincterotomy remains the gold standard surgery for chronic AF, it still has a considerable rate of anal incontinence. The aim of this study is to describe an alternative and minimally invasive technique for the treatment of AF using photobiomodulation and high-power laser (Laser Fissure Treatment - LFT), and to present the initial results, primarily evaluating pain relief in both acute and chronic AF.

Methods A retrospective study was conducted with 38 patients treated on an outpatient basis with LFT in three different hospitals across different states in Brazil (Santa Catarina, Paraná, and São Paulo). The objective was to assess the effects of LFT treatment on pain and incontinence rates in patients with AF after the procedure. The Wilcoxon test was used to identify the effects of LFT treatment over time (D0, D7, D15, D30, and D60). For post-operative pain intensity, the Visual Analog Scale (VAS) was used; and for the analysis of anal incontinence, the Wexner scale was applied.

Results Of the patients, 65.79% (n=25) were male. The median age was 49 years. Constipation was reported by 31.5%; 13% were smokers, and 21% had recently used opioids. In 92.1% of cases, AF was located posteriorly. Skin tags were present in 26.9%, and 21% had recently undergone prior anal surgeries. A significant reduction in pain over time was observed, with post-operative pain intensity measured by the VAS. Before surgery (D0), the average VAS score was 4.08, progressively decreasing to 0.06 by day 60 post-operatively (P < 0.05). No significant changes in fecal continence were observed by the end of the 60-day follow-up period. Complications occurred in 3 patients (1 hemorrhoidal thrombosis, 1 skin tag, and 1 “failure”). The recurrence rate was low, with only one reported case. Satisfaction after 90 days was present in 93.6%.

Conclusion The results suggest that the treatment of anal fissure with laser therapy leads to a significant reduction in pain intensity over time, without affecting anal continence.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025