Chronic Anal Fissure; Comparison of Lateral Anal Sphincterotomy (closed Method) versus Anal Dilatation

INTRODUCTION removed/ treated. Mostly, such types of fissures are Anal fissure is a distinct clinicopathological condition of situated eccentrically around the anal margin. the lower anal canal. It can be defined as a longitudinal ulcer in the anoderm usually in the posterior midline, less There is no trace of surgery of anal fissure in literature th frequently in the anterior midline, and rarely in the lateral before 19 century. At that time only conservative 1-4 position of the anal canal . When traction is applied on measures such as high fiber diet and stool softeners each side of the anus, the fissure appears to be triangular were prescribed. Recamier recommended stretching of in shape, with the apex near the dentate line and the base anal sphincter in 1829, which became popular in 1968 1,5 when Lord also used this procedure on a large number of over the lower anal canal . 3,4,5,6 patients . High ratios of complications lead The fissures can be divided into the idiopathic or primary Eisenhammer to describe internal sphincterotomy by type and the secondary type. The primary type is most dividing the sphincter in the posterior midline. Due to the common but the exact cause of this type of fissure is not comparatively long healing time required for this type of 2-4 operation Parks described open LAS in 1967.This was known . Commonly such type of fissure is present in the further simplified to the closed lateral anal midline, posteriorly or anteriorly. If the primary fissure is sphincterotomy by Notaras in 1969. not treated in its acute stage then permanent organic changes take place in tissues leading to chronic stage. Now days, a plethora of surgical techniques are in vogue These are indurations of the ulcer margins, fibrosis in the worldwide. An ideal management of primary chronic anal ulcer base, development of sentinel pile and anal papilla. fissure continues to be a subject of debate especially for The secondary types of fissures are caused by some the young surgeons and those working in the peripheral pathological conditions of the anal canal such as Crohn’s 1hospitals having limited surgical facilities. The four disease, ulcerative colitis, trauma, operation or infection 5 fingers AD and LAS, especially closed method are being . They will heal only when that causative pathology is ORIGINAL PROF-1233 CHRONIC ANAL FISSURE; COMPARISON OF LATERAL ANAL SPHINCTEROTOMY (CLOSED METHOD) VERSUS ANAL DILATATION