Scanner-Assisted CO2 Laser Fissurectomy: A Pilot Study

Abstract

Introduction: Surgery for chronic anal fissure is challenging for every proctologist. Solving the pain by guaranteeing rapid and effective healing is the objective, but what is the price to pay today in functional terms? Though this result is nowadays partially achievable through interventions that include the execution of an internal sphincterotomy among the procedures, it is necessary to underline the high rate of patients who can present faecal incontinence. The aim of this study is to explore the effectiveness of scanner-assisted CO2 laser fissurectomy.Methods: From April 2021 to September 2021, all consecutive patients who affected by chronic anal fissure suitable for surgery, meeting the inclusion and exclusion criteria, were evaluated. All planned data were recorded before surgery, then at 24 h, 1 week, and 1 month follow-up. A scanner-assisted CO2 laser was used in this study to achieve a smooth and dried wound with a minimal tissue thermal damage, to ensure good postsurgical pain control, rapid and functional, elastic and stable healing, and to prevent potential relapses. Paracetamol 1 g every 8 h was prescribed for the first 24 h and then continued according to each patient's need. Ketorolac 15 mg was prescribed as rescue.Results: Mean pain intensity ≤3, considered as the principal endpoint, was recorded in 26 out of the 29 patients who enrolled in the study with a final success rate of 89.7% at 1-month follow-up. Pain and anal itching showed a statistically significant reduction while bleeding, burning, and maximum pain, and REALIS score showed a reduction too at the end of the follow-up period. Reepithelisation proved to be extremely fast and effective: 22 of 29 (75.9%) showed a complete healing and 5 showed a partial reepithelisation at 1-month follow-up.Discussion: Outcomes of this study showed that it is undoubtedly necessary to change the surgical approach in case of anal fissure. The internal sphincterotomy procedure must be most of all questioned, where the availability of cutting-edge technological tools must be avoided and offered only in selected cases. Scanner-assisted CO2 laser showed great results in terms of pain control and wound healing, secondary to an extremely precise ablation, vaporisation, and debridement procedures with minimal lateral thermal damage.

Superficial Peritoneal Endometriosis Vaporization Using a CO2 Laser: A Long-Term Single-Center Experience

“…Scanning-aided “free beam” laser surgery is the only technology that enables the surgeon to control the ablation depth and the thermal effect for each scanning passage. Moreover, scanning technology has already been intensively used in many fields of surgery like Gynecology, Colposcopy, Ears-Nose-Throat, Neurosurgery, and General Surgery (i.e., Proctology and Wound Healing) [ 26 , 27 , 28 , 29 , 30 ]. The CO 2 laser can also be delivered using a flexible hollow fiber (i.e., Smartxide2 TRIO System, DEKA, Calenzano, Italy).…”

A review of recent advances in the surgical management of anal fissures

“…Numerous studies have shown that laser exposure can start the regeneration of various tissues because it encourages the development of fibroblasts, increased epidermal growth, collagen formation, vascular structure growth, and total healing. 4,5,21 In a specific study from 2017 conducted on 200 patients suffering from chronic anal fissures, minimally invasive laser electrocoagulation with the help of nitroglycerine or nifedipine was evaluated using anesthesia. The internal sphincter and its margins stay completely unaffected by the electrocoagulation of the fissure.…”