Carefully dilate the anal canal and then insert the anal retractor.
The chronic fissure in ano with a sentinel skin tag and proximal anal fibroma is seen at the posterior circumference.
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Inspection
![Inspection]()
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Excising the fissure and secondary changes
![Excising the fissure and secondary changes]()
Flat, tangential excision of all altered tissue while sparing the internal anal sphincter muscle.
