Pravin J Gupta.
Closed anal sphincter manipulation: an alternative to anal stretch or sphincterotomy in chronic anal fissure.
Pak J Surg Jan ;22(4):231-4.

Objective: To assess the outcome of Closed Manipulation of the fibers of the internal anal sphincter in cases of Chronic Anal Fissures. Design & Duration: Prospective, descriptive study from Jan. 2005 to July 2005. Setting: Gupta Nursing Home, Laxminagar, Nagpur, India. Patients: 48 patients with Chronic Anal Fissure. Methodology: The patients underwent history taking, examination and investigations. Pre-operative and post-opera- tive anal manometry was performed. Post-operative complications were noted, and early and 6-months follow-up results were recorded. Results: Fissure healing and relief of symptoms was observed in 94% of the patients. The notable complications included ecchymosis and haematoma. A transient, variable degree of incontinence occurred in three patients. Conclusion: Manipulation of internal anal sphincter is an easy, safe and effective procedure for the treatment of Chronic Anal Fissure.

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