Open lateral sphincterotomy is still the best treatment for chronic anal fissure

Chronic anal fissure is the main cause of anal pain and is very common. Many treatment modalities have been tried—none is ideal. Recently, topical nitric oxide releasing agents and botulin toxin injections have been used, trying to replace surgery. No long-term experience is available. Personal experience with 2,108 open, ambulatory, lateral sphincterotomy with follow-up of 4–20 years is presented.