All are the treatment of acute fissure in ano except one -
Treatment of Anal fissure
The object of all t/t is to obtain complete relaxation of the internal sphincter.
Conservative t/t

Stool bulking agents and stool softeners.
Nitric oxide or Glyceryl trinitrate is 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 mobilization 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.

A fissure in Ano (or Anal fissure) 

A most common site is → mid-line posteriorly.
MC symptom is → pain associated with defecation.
Fissure starts proximally at the dentate line. So the whole of anal fissure lies in the pain-sensitive part 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 hypertrophied papilla.
At the lower end there is a skin tag k/a sentinel pile.
Conservative
Dilatation under GA
Lateral sphincterotomy
External sphincterotomy