Conventional Lateral Internal Sphincterotomy, V-Y Anoplasty and Tailored Lateral Internal Sphincterotomy With V-YF in Treatment of Chronic Anal Fissure(CAF)

Inclusion Criteria: * consecutive patients who treated for chronic anal fissure at colorectal surgery unite of Mansoura university hospital, Mansoura, Egypt. * all patients were selected to have increased resting anal pressure above the upper limit of normal range. Exclusion Criteria: * patients with acute fissure * patients who had resting anal pressure within the normal range or less than the normal * cicatricial deformation * large sentinel pile * inflammatory bowel disease hemorrhoids * fistula in ano and anal abscesses * those who had undergone previous surgical procedure in the anal canal * age above 80 years * vascular disease * scleroderma * malnutrition * coagulopathy