Laser-based treatment of chronic anal fissures: a report of two cases

Chronic anal fissures (CAF) are painful and often resistant to medical therapy. While lateral internal sphincterotomy is effective, it carries a risk of incontinence. Laser Fissuroplasty (LaFiP) is a minimally invasive alternative gaining traction globally. We report two male patients aged 28 and 47 years, respectively, with CAF unresponsive to medical therapy. Both presented with severe post-defecation anal pain and were diagnosed with posterior midline fissures. LaFiP was performed under pudendal block using 350-400 joules of energy from a 1470 nm diode laser. Postoperatively, both experienced rapid symptom resolution and complete healing within weeks, with no incontinence at 6-month follow-up. LaFiP appears to be a safe and effective technique for managing CAF, particularly suitable for patients at risk of incontinence. Although limited by a short follow-up of six months, initial results from these two cases were promising. Nonetheless, the long-term durability of the intervention requires further study.