Treatment of anal fissures with J Plasma

Anal fissures are small tears in the mucous membrane of the anus that cause a very painful problem, because they are located in an extremely sensitive area. The condition affects about 15% of the population (both women and men). The treatments available so far were either relatively inadequate or accompanied by postoperative discomfort. Fortunately, the problem has now found a permanent solution thanks to a new innovative and internationally acclaimed method applied for the first time at the Metropolitan Hospital. The doctor who performed it, Anastasios Karandreas, MD, Ph.D, FACS, Chief Surgeon at the Metropolitan Hospital, informs us about it.

What are anal fissures?

Anal fissures are described as a painful condition that affects the anus. Essentially, an anal fissure is a small “crack” in the mucous membrane of the anus with a disruption of its continuity, resulting in a local ulcer which causes a very painful condition during defecation and for several hours afterwards.

What is the cause?

One characteristic of this condition is that patients tend to avoid defecation as much as possible, due to the painful situation they expect to face. The condition itself may be due to constipation or even severe hypertension of the internal sphincter of the area.


Apart from pain, there is usually also bleeding during defecation.


The diagnosis is combined. It is based on the patient’s history, which is overtly clear, and, of course, on clinical examination. During clinical examination, an ulcer is observed in the outer orifice of the anus, which is often so deep that the fibers of the inner sphincter become visible.

Characteristic is the very painful finger examination over the fissure, especially at the “6 o’clock” site (i.e. at the site that corresponds to number 6 on the dial of a clock) of the anal ring, where 90% of the fissures are located.


Treatment can be conservative, with improved nutrition resulting in improved bowel movements, or with application of topical nitrite ointments. Both methods have proven to produce poor results.

Until recently, the method of choice for the definitive treatment of the condition was surgical lateral sphincterotomy. However, thanks to the progress of science and a hi-tech approach, a new method for the treatment of fissures has become possible using J Plasma, a technique that was first applied in Greece at the Metropolitan Hospital.

What is the innovative feature of j-plasma?

The fissure is sprayed with a special material (helium gas) which destroys the scar tissue and slowly restores the continuity of the mucosa, without major trauma. In combination with cool coagulation, this method allows painless and permanent treatment of fissures. It is done under local anesthesia (saddle block) by a specialized anesthesiologist and on a one day clinic basis. Unlike older surgical procedures, injury to the area is avoided, as is the degree of incontinence that resulted for a few weeks or even months. Thus, the patient’s discomfort is significantly reduced.



Chief Surgeon