الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
In summary, anal fissures are a common problem that can usually be identified by an attentive history and limited physical examination. Initial management should consist of conservative, nonoperative treatments, as most fissures heal with minimal intervention. Medical options exist for treatment of chronic fissures, but none have proven to be superior to lateral internal sphincterotomy.
Lateral internal sphincterotomy has been the standard treatment for chronic anal fissure, but fissure healing rates of up to 80% with topical glyceryl trinitrate (GTN) 0.5% cream treatment have suggested that this operation may become redundant. We use Anorectal Manometry to evaluate the results of topical treatment of chronic anal fissures with GTN 0.5% for 6 weeks in the outpatient clinical setting with the results of treatment by lateral internal sphincterotomy.
GTN 0.5% cream is safe with high rate of healing of fissure without the risk of incontinence and minimal side effects, though symptomatic relief occurs at slower rate than that of surgical sphincterotomy. Lateral internal sphincterotomy is still a better surgical intervention used for chronic anal fissure, it offer early symptomatic relief and rapid healing of fissure but with higher rate of incontinence. Finally we supposed that G.T.N 0.5% cream is the first line of treatment of chronic anal fissure and use of surgical sphinectotomy only in failure of medical treatment and recurrent cases.