All are treatment of acute fissure in ano except one -

Ans is 'd' ie External sphincterotomy Treatment of Anal fissure Object of all tit is to obtain complete relaxation of the internal sphincter. Conservative tit - Stool bulking agents and stool softners - Nitric oxide or Glyceryl trinitrate are applied as an ointment to the anal canal produce sufficient relaxation of the sphincter to allow the fissure to heal up in 2/3 of pts. (k/a chemical Sphincterotomy) Dilatation of the sphincter under GA Lateral anal sphincterotomy - the internal sphincter is divided away from the fissure itself - usually either in the right or the left lateral position. Anal advancement flap - this operation consists of excision of the edges of the fissure and mobilisation of a square, full thickness anal skin flap so that this can be slid forward over the fissure and sutured in place. This technique has become popular recently as there is little risk of damage to the underlying internal sphincter and incontinence is unlikely. Fissure in Ano (or Anal fissure) Most common site is ----> mid-line posterioly MC symptom is --> pain associated with defecation Fissure stas proximally at the dentate line. So whole of anal fissure lies in the pain sensitive pa of the anal canal. The bleeding of anal fissure occurs as streaks on the outside of the stool or spots noted on toilet paper. There are 2 types of fissures - Acute & Chronic Chronic fissure is a deep canoe shaped ulcer with thick edematous margins at the upper end there is hyperophied papilla* at the lower end there is a skin tag k/a sentinel pile*