Anesthesia: Local anesthesia with sedation or regional anesthesia
Position: Prone i.e. patient lying on the stomach or lithotomy
Procedure: The ulcer is excised by separating from the underneath muscles. Then a wedge partial sphincterotomy is done. After hemostasis the mucosa is hitched by marsupilization or by suturing to the skin edge. The excised ulcer is sent for histopathology. The anal canal is packed which is removed on the next day or comes out on its own when patient passes stool.
Post op: Patient is given antibiotics, pain killers, stool softeners and local ointment for management of the wound. A specific dressing is taught which has to be followed. Instructions are given regarding food habits and sitz bath if needed. Patients will experience pain for the first 2 to 3 days while passing motion which is relieved by medications. Patients can start work on the 3rd day and can have a routine lifestyle by 3rd or 4th week.
Follow up: Patient is followed up after 4 days and then weekly till the wound heals.