Anal fissure and stenosis.

Fissure in ano is a simple condition that causes considerable discomfort. The acute forms should be treated by conservative nonsurgical regimens initially. If the patient finds the symptoms intolerable, or if the fissure demonstrates signs of chronicity, then lateral subcutaneous sphincterotomy is recommended as an ideal simple surgical procedure that has the advantages of a low complication rate and low morbidity. It is easily performed under local anesthesia and does not require hospitalization. It is gratifyingly satisfying for both the patient and surgeon. Certain types of anal stenosis, especially those following hemorrhoidectomy, are successfully managed by lateral sphincterotomy combined with postoperative anal dilatation. This approach avoids the more complicated plastic anal procedures that have been used in the past.