الفهرس 
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Abstract
In this study 24 female patients with chronic anal fissure were divided into two groups according to preoperative anorectal manometry; patients with increased resting anal pressure underwent LIS (group 1, no=16)and patients with normal or decreased anal pressure underwent V-Y advancement flap(group 2, no=8) .There were no significant differences between the two groups regarding preoperative patient characteristics in terms of clinical presentation ,duration of symptoms and preoperative pain score. Patients were subjected to preoperative assessment which included careful history taking, meticulous clinical examination, and anorectal manometry. Preoperative written consent was taken from the patients. The first group underwent lateral internal sphincterotomy and the second group underwent V-Y advancement flap. Patients were followed up for one year. During each visit, complete assessment of the patient was done including assessment of healing, pain, recurrence and anal sphincter dysfunction. After collection and analyzing these data, we found that both groups achieved comparable time to complete healing comparable improvement in symptoms, similar postoperative pain scores, similar rates of postoperative FI and recurrence of anal fissure at 12 months of follow-up not happened in both groups. Flap disruption occurred in 2 patients of group 2. On measuring anal pressures group 1 had significant high MRP than group 2 owing to the selection criteria of the study. Postoperatively, significant decrease in anal pressure was noted in group 1, while no significant decrease in anal pressure was noted in group 2. Postoperative bleeding occurred in 6 % of patients of group 1 and none of patients of group 2. Minor transient fecal incontinence developed in one patient of patients of group 1 and none of patients of group 2 suffered from postoperative FI. Incidence of recurrence of anal fissure at 12 months of follow-up was 0% in both groups. In conclusion of the study selection of the method of surgical treatment for chronic anal fissure depending on preoperative anal pressure has been achieved the best possible outcomes in both groups regarding symptoms improvement, healing and recurrence along with the least possible continence disturbance. Therefore, we recommend tailoring surgical treatment for patient with chronic anal fissure according to preoperative anal sphincter and anal pressure state.