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Asked 14th Nov, 2012
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What is the ideal extent of lateral internal sphicterotomy ?

Should we end up at the apex of the anal fissure or reach up to dentate line irrespective of the extent of fissue?
16th Nov, 2012
Jonathan N Lund
The lateral sphincterotomy should be "tailored" to the length of the fissure. Cutting to the dentate line is too far and results in greater incidence of impairment of continence, especially in women who have shorter internal sphincters and who also have a much greater chance of having a co-existinf or future obstetric sphincter injury.
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