At a glance
This guide covers what happens on the day of a fissurectomy — the practical, step-by-step experience of the procedure itself. Not the recovery (that is covered in our fissurectomy guide and the fissurectomy recovery experience), but the day: what to expect from arrival at the hospital through to going home.
If you have a fissurectomy scheduled or are considering it, knowing what the day actually involves can reduce the anxiety that comes from the unknown. People who have been through it consistently say the anticipation was worse than the reality.
Before the day: practical preparation
Your surgical team will provide specific pre-operative instructions. These typically include:
- Fasting — no food or drink for a set number of hours before the procedure (usually 6 to 8 hours for food, 2 hours for clear fluids). This is for anaesthesia safety.
- Medications — your team will advise which regular medications to take or skip on the morning of surgery.
- Bowel preparation — some surgeons ask patients to use an enema or similar preparation before the procedure. Others do not. Follow your surgeon’s specific instructions.
- What to bring — loose, comfortable clothing for going home. Sanitary pads in case of minor post-operative bleeding. Any medications you have been told to bring.
- What to arrange — someone to drive you home and stay with you for the first night. Time off work — typically one to two weeks, depending on your job and your surgeon’s advice.
- Stool softeners and fibre — many surgeons recommend starting these several days before the procedure so your stools are already soft when recovery begins.
Arriving at the hospital
Fissurectomy is typically a day procedure, meaning you arrive in the morning and go home later the same day. People describe the arrival process as:
- Check-in and waiting — you will be checked in, shown to a bed or bay, and given a hospital gown. There is usually a waiting period. People consistently describe this as the hardest part of the day. The procedure itself passes quickly. The waiting does not.
- Pre-operative checks — a nurse will check your vital signs, confirm your details, and review your medical history. You may have a cannula (IV line) placed for fluids and medication.
- Meeting the anaesthetist — the anaesthetist will visit to discuss the anaesthesia plan, ask about allergies and previous reactions, and answer your questions.
- Meeting the surgeon — your surgeon will visit to confirm the procedure, mark the site if needed, and give you a chance to ask any last questions. This is your final opportunity to raise concerns.
- Consent — you will sign a consent form confirming you understand the procedure and its risks. You should already have discussed this in detail at a previous appointment, but do not hesitate to ask for clarification.
People describe the emotional state during this period as a mixture of anxiety, impatience, and a desire to just get it done. Bringing something to read or listen to can help pass the time.
Anaesthesia: what to expect
Most fissurectomies are performed under one of two main anaesthesia types:
General anaesthesia — you are fully asleep. You will not be aware of or remember anything about the procedure. This is the most common approach. You will breathe through a mask as the anaesthetic takes effect, and the next thing you are aware of is waking up in the recovery area.
Regional or spinal anaesthesia — you are awake but numb from the waist down. You cannot feel the procedure. Some people find this option less daunting because it avoids general anaesthesia. Others prefer to be completely unaware. Your anaesthetist can discuss which approach is suitable for you.
Some centres use local anaesthesia with sedation for simpler fissurectomies. You are awake but relaxed and drowsy, with the specific area numbed. This is less common but may be offered depending on the complexity of the procedure.
People describe the anaesthesia process as quick and straightforward. The moment of going under general anaesthesia is often described as unexpectedly fast — a few breaths through a mask and then waking up in recovery.
The procedure itself
You will not be aware of the procedure if you are under general anaesthesia. But understanding what happens can reduce anxiety beforehand.
Positioning
For fissurectomy, the surgeon needs clear access to the anal area. The most common positions are:
- Lithotomy position — lying on your back with legs raised and supported in stirrups. This is the most commonly described position.
- Prone (jackknife) position — lying face down with the hips slightly elevated.
- Left lateral position — lying on your left side with knees drawn up.
The position depends on your surgeon’s preference and the location of the fissure. You will be positioned after anaesthesia takes effect, so you will not need to do anything.
What the surgeon does
The core of the procedure involves:
Examination — the surgeon examines the fissure and surrounding tissue under anaesthesia. This allows a thorough assessment that is not possible when the area is painful and the sphincter is in spasm.
Excision of the fissure — the surgeon carefully cuts away the chronic fissure tissue. This includes the scarred, fibrotic tissue that has lost its ability to heal on its own.
Removal of the sentinel pile — if a sentinel pile (skin tag) has formed at the outer edge of the fissure, it is removed during the same step. This is a common part of fissurectomy.
Removal of hypertrophied papilla — if excess tissue has developed at the inner end of the fissure, this is also excised.
Creating clean wound edges — the surgeon trims back any thickened or fibrotic tissue at the wound margins. The goal is fresh, healthy tissue edges that can heal properly.
Leaving the wound open — the wound is left open intentionally. This is standard practice. Open wounds in this location heal more reliably than sutured ones. The wound will granulate — fill in with healthy tissue from the bottom up — over the following weeks.
Additional procedures if planned — if botox or a sphincterotomy is being done at the same time, this happens during the same operation. Your surgeon will have discussed this with you beforehand.
Duration
The procedure itself typically takes 20 to 40 minutes. If additional procedures are being performed (botox injection, sphincterotomy, removal of multiple fissures), it may take slightly longer.
The time you are actually in the operating theatre, including anaesthesia induction and positioning, is usually 30 to 60 minutes. The surgery within that time is the shorter portion.
Waking up and the recovery room
After the procedure, you are moved to a recovery area where staff monitor you as the anaesthesia wears off.
What people describe:
- Grogginess — the most common immediate sensation. Feeling foggy, sleepy, and slightly disoriented is normal and expected.
- Numbness — the surgical area may still be numb from local anaesthetic applied during the procedure. This can last several hours. People describe this as a welcome buffer.
- Mild nausea — some people experience nausea from the anaesthesia. This is usually managed with anti-nausea medication.
- Thirst and dry mouth — common after fasting and anaesthesia. You will be offered water and light food once the staff are satisfied you are recovering well.
- Awareness that something is different — many people describe a sense that the area feels different, even through the numbness. The chronic fissure pain that was their constant companion may already feel changed.
The recovery room period typically lasts one to two hours. Staff will monitor your blood pressure, heart rate, and pain levels.
Before going home
Before discharge, your team will typically:
- Ensure your pain is manageable — you will be given pain medication to take home, along with instructions for when and how to take it.
- Provide wound care instructions — how to keep the area clean, what to expect from the wound, and what is normal versus concerning.
- Discuss bowel management — stool softeners, fibre, hydration, and the importance of keeping stools soft during the healing window.
- Explain follow-up — when your next appointment is and what to watch for in the meantime.
- Check you can urinate — difficulty passing urine after anal surgery under anaesthesia can occasionally occur. Staff will want to confirm this is working before you leave.
- Confirm your transport — someone needs to collect you. You cannot drive yourself.
People describe the discharge conversation as happening while still somewhat groggy. Having your companion listen too, or asking for written instructions, is practical advice that people consistently offer.
Going home: the first hours
The journey home is short but significant. People describe:
- Discomfort in the car — sitting on the surgical area can be uncomfortable. A cushion or pillow can help. Some people lie on their side in the back seat.
- The numbness wearing off — over the first few hours at home, the local anaesthetic fades and the surgical soreness arrives. This is expected. Take pain relief as directed rather than waiting for pain to build.
- Wanting to sleep — the combination of anaesthesia, emotional relief, and physical tiredness means many people sleep for much of the first afternoon and evening.
- The wound — there may be a dressing or gauze pad in place. There may be some minor bleeding or oozing, which is normal. Your discharge instructions will explain what to expect and when to change dressings.
The first 24 hours at home are about rest, managing pain, and beginning the recovery routine. Nothing more is expected of you. People who give themselves permission to do absolutely nothing on this first day describe it as the right approach.
What you will not see or feel
Some reassuring points people wish they had known:
- You will not see the surgery. Under general anaesthesia, you are asleep. Under regional, the surgical area is below the drapes. The procedure happens without your visual involvement.
- The wound is smaller than you imagine. People who were anxious about a large wound often describe being surprised at how contained it is.
- The procedure is routine for your surgeon. What feels like an enormous event for you is a standard operation for your surgical team. They have done this many times. Take comfort in their experience.
- The hospital environment is calm. People often expect a dramatic experience and find it surprisingly mundane. Check in, wait, go under, wake up, go home.
When to contact your doctor
After the procedure, contact your surgical team if you experience:
- Heavy bleeding that soaks through dressings and is not slowing
- Fever or signs of infection — redness, swelling, warmth, or discharge from the wound
- Pain that is worsening rather than gradually improving after the first few days
- Difficulty with bowel or bladder control
- Any symptom that concerns you or does not feel right
If you experience heavy bleeding, fever, or sudden severe pain, seek medical care promptly.