**1. Introduction**

An anal fissure is one of the most encountered anorectal diseases by general surgeons, although the true prevalence is unknown [1]. It is described as a tear developing in the squamous epithelium of the anoderm and is located between the dentate line and the anal verge [2].

This condition is often related to chronic constipation and difficulty of defecation and rarely can result from Crohn's disease, tuberculosis, and Acquired Immune Deficiency Syndrome (AIDS). The most common location of the fissure is the posterior midline (90%), followed by the anterior midline (1–10%), and lateral (1%). Lateral fissures can be associated with an underlying disease and should be thoroughly investigated. Typical symptoms are anal pain during defecation, bleeding, pruritus, and soiling.

An anal fissure can be described as acute and chronic according to the duration of symptoms. An acute fissure is a superficial lesion that usually occurs after constipation/ diarrhea and can be healed with conservative management in 4 to 6 weeks. In contrast, chronic anal fissure is a deeper lesion surrounded by scar tissue caused by chronic inflammation. Chronic inflammation can cause skin tags in the anoderm adjacent to the fissure and hypertrophic papilla in the anal canal. Medical treatment is often ineffective for chronic fissures, and the patient's symptoms are prolonged to 6 to 8 weeks.
