Lateral Internal Sphincterotomy for Chronic Anal Fissure

  • Jameson L. Chassin


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 and sitz baths, 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.


Anal Canal Anal Fissure Dentate Line External Sphincter Internal Sphincter 
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Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • Jameson L. Chassin
    • 1
    • 2
  1. 1.Clinical SurgeryNew York University School of MedicineNew YorkUSA
  2. 2.Department of SurgeryNew York Hospital Medical Center of QueensFlushingUSA

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