Careful dilation of the anal canal followed by the insertion of the anal retractor. At the posterior anal circumference, the chronic anal fissure is observed with an overlying skin tag and proximal anal fibroma.
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Inspection
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Excision of the Fissure and Secondary Changes
Flat, tangential excision of all altered tissue while preserving the internal anal sphincter muscle
Flat, tangential excision of all altered tissue while preserving the internal anal sphincter muscle
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