Lateral Internal Sphincterotomy for Chronic Anal Fissure
A typical anal fissure presents in its acute stage as a linear superficial tear, always distal to the dentate line and in 90% of cases in the posterior commissure of the anus. It is believed to result from the trauma of passing an inspissated stool. In the acute stage, conservative management aimed at softening the stool, combined with the local application of an anesthetic ointment may reverse the pathology in less than a week’s time. When the narrow linear fissure becomes chronic, it resembles an ulcer with slightly thickened sides, measuring perhaps 1–2 mm in thickness, and the fissure widens for a distance of 3–6 mm. Characteristically, the base of a chronic anal fissure demonstrates transverse muscle fibers of the circular muscle that constitutes the internal sphincter. Further along in the development of a chronic anal fissure, a sentinel pile develops. This is an inflammatory thickening of the skin situated at the distal margin of the fissure. Once the anal fissure has reached a chronic stage, it is theorized that spasm of the internal sphincter prevents healing, while at the same time the spasm produces the intense pain on defecation that constitutes the patient’s chief complaint.
KeywordsAnal Canal Anal Fissure Dentate Line Internal Sphincter Chronic Anal Fissure
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