Surgical Anatomy of the Anal Canal
Layers, landmarks, and why posterior midline dominates
Fig 1. Schematic cross-section of the anal canal showing key anatomical layers and landmarks
🏗️ Anatomical Layers
Anal Canal Length: 3–4 cm from anal verge to anorectal junction (pelvic floor/puborectalis)
| Structure | Notes |
|---|---|
| IAS Internal Anal Sphincter | Smooth muscle, involuntary; distal 2/3 of anal canal; forms the high-pressure zone. Target of LIS |
| EAS External Anal Sphincter | Skeletal muscle, voluntary; surrounds IAS; 3 parts: subcutaneous, superficial, deep |
| Dentate Line | Pectinate line at 1.5 cm from verge; divides visceral (above) from somatic (below) innervation |
| Intersphincteric Groove | Palpable groove between IAS & EAS; landmark for LIS incision placement |
| Anal Columns (Morgagni) | 8–14 vertical mucosal folds above dentate line; bases form anal crypts & papillae |
📍 Why Posterior Midline?
Approximately 90% of anal fissures occur in the posterior midline, with anterior fissures (10%) predominantly in females. This anatomical predilection is explained by:
- Vascular watershed area: The posterior commissure receives the poorest blood supply from the inferior rectal artery branches — making it vulnerable to ischaemia during spasm.
- Mechanical stress: The anterior-posterior elongation of the anal orifice concentrates the maximal shear force at the posterior commissure during defecation.
- IAS angulation: The puborectalis creates a forward pull, causing greater stretch posteriorly.
- Lack of subcutaneous support: The posterior sphincter complex has less subcutaneous fat cushioning compared to anterolateral portions.
⚠️ Atypical site fissures (lateral, multiple, or irregular) must raise suspicion for secondary causes: Crohn's disease, TB, HIV, syphilis, or malignancy → biopsy mandatory
🩸 Blood Supply & Why Ischaemia Matters
The anal canal is supplied by the inferior rectal (haemorrhoidal) artery (branch of internal pudendal), the middle rectal artery (branch of internal iliac), and the superior rectal artery (continuation of inferior mesenteric).
Resting IAS pressure in chronic fissure patients is significantly elevated (~100 mmHg vs normal ~60–80 mmHg), causing relative ischaemia at the posterior commissure — impeding healing and perpetuating the fissure.
Key Pressure Data:
• Normal resting anal pressure: 60–80 mmHg
• Chronic fissure patients: 90–120 mmHg
• Threshold for mucosal ischaemia: ~80 mmHg
• LIS target: reduce pressure to <80 mmHg
• Normal resting anal pressure: 60–80 mmHg
• Chronic fissure patients: 90–120 mmHg
• Threshold for mucosal ischaemia: ~80 mmHg
• LIS target: reduce pressure to <80 mmHg
Healing requires: Adequate perfusion → LIS reduces IAS tone → improves posterior commissure blood flow → enables wound healing
Pathophysiology
The ischaemia-spasm vicious cycle and how LIS breaks it
🔄 The Vicious Cycle of Chronic Fissure
💥 Precipitating Factor
(hard stool, constipation, straining, diarrhoea)
(hard stool, constipation, straining, diarrhoea)
↓
🔴 Mucosal Tear at Posterior Commissure
↓
⚡ Pain → Reflex IAS Spasm
↓
🩸 Elevated Resting Anal Pressure (↑↑ IAS tone)
↓
💧 Reduced Posterior Commissure Blood Flow (Ischaemia)
↓
🔁 Non-healing Wound → Chronic Fissure
↓
↩️ Defecation Attempt → Pain Worsens → Cycle Continues
🎯 LIS breaks this cycle by dividing a portion of the IAS → reduces resting pressure → improves posterior blood flow → enables healing
🧠 Rectoanal Inhibitory Reflex (RAIR)
The RAIR is the involuntary relaxation of the IAS in response to rectal distension — mediated by the myenteric (Auerbach's) plexus and NO/VIP neurotransmitters.
Normal RAIR Sequence:
1. Rectal distension (stool/flatus)
2. Stretch receptors activated
3. Myenteric plexus mediates IAS relaxation
4. EAS voluntary contraction maintains continence
5. "Sampling" of rectal content at dentate line
6. Conscious decision to defer or defecate
1. Rectal distension (stool/flatus)
2. Stretch receptors activated
3. Myenteric plexus mediates IAS relaxation
4. EAS voluntary contraction maintains continence
5. "Sampling" of rectal content at dentate line
6. Conscious decision to defer or defecate
🔺 In Chronic Fissure
- Baseline IAS tone pathologically elevated
- RAIR preserved but insufficient to overcome hypertonia
- Defecation-induced pain → vicious avoidance cycle
- Manometry: ultra-high resting pressure with poor relaxation
- Post-LIS: normalised resting pressure, preserved RAIR
⚗️ Mediators & Neurotransmitters
| Mediator | Role | Therapeutic Target |
|---|---|---|
| Nitric Oxide (NO) | IAS relaxation | GTN 0.2% (NO donor) |
| Acetylcholine | IAS contraction | Diltiazem (Ca²⁺ blocker) |
| Noradrenaline | IAS contraction | — |
| VIP | IAS relaxation (RAIR) | — |
| Substance P | Pain sensitization | Improved by healing |
| Botulinum Toxin | Blocks ACh at NMJ | Chemical sphincterotomy |
💊 Pharmacological Basis of Conservative Treatment
GTN 0.2% Topical
Releases NO → relaxes IAS → ↓ resting pressure by 30–40% → improves ischaemic posterior mucosa
SE: Headache (25–30%), tachyphylaxis
Releases NO → relaxes IAS → ↓ resting pressure by 30–40% → improves ischaemic posterior mucosa
SE: Headache (25–30%), tachyphylaxis
Diltiazem 2% Topical / Oral
Calcium channel blockade → smooth muscle relaxation of IAS → ↓ resting pressure
Fewer headaches than GTN; similar efficacy
Calcium channel blockade → smooth muscle relaxation of IAS → ↓ resting pressure
Fewer headaches than GTN; similar efficacy
Botulinum Toxin (Botox)
Injected into IAS → blocks presynaptic ACh release → chemical sphincterotomy (3–6 months)
Reversible; 60–80% success; can repeat
Injected into IAS → blocks presynaptic ACh release → chemical sphincterotomy (3–6 months)
Reversible; 60–80% success; can repeat
Etiopathology
Causes, classical triad, and histopathological features
⚙️ Aetiology
| Category | Specific Cause |
|---|---|
| Primary / Idiopathic | Constipation, hard stools, straining at defecation (most common) |
| Primary | Diarrhoea, explosive loose motions (especially infants) |
| Obstetric | Childbirth trauma, episiotomy → anterior fissures in females |
| Inflammatory | Crohn's disease → atypical, multiple, irregular fissures |
| Infectious | TB, HIV, syphilis, herpes, CMV |
| Neoplastic | Squamous cell carcinoma, Bowen's disease |
| Iatrogenic | Post-haemorrhoidectomy, post-dilation |
| Haematological | Leukaemia, aplastic anaemia |
🔺 Classical TRIAD of Chronic Fissure in Ano
1️⃣
Chronic Ulcer (The Fissure)
Indurated edges, pale/white base exposing horizontal IAS fibres. Typically posterior midline. >6 weeks duration.
2️⃣
Sentinel Pile (External Tag)
Hypertrophied, oedematous skin tag at the distal end (anal verge). Represents chronic inflammation and lymphatic obstruction. Pathognomonic of chronicity.
3️⃣
Hypertrophied Anal Papilla (Internal Tag)
Enlarged fibrous papilla at the proximal end (dentate line). Represents reactive hyperplasia from chronic irritation. Occasionally symptomatic (prolapse).
Mnemonic: "UPS" — Ulcer + Pile (sentinel) + Spapilla (hypertrophied) = Complete chronic fissure triad
🔭 Histopathological Features
Chronic fissure histology reflects the combination of ischaemia, inflammation, and failed healing:
- Indurated, fibrotic edges: Dense collagen deposition; loss of normal epithelial architecture; failure of re-epithelialisation
- Exposed IAS fibres: The base shows horizontal striated smooth muscle fibres — pathognomonic of depth of involvement
- Chronic inflammatory infiltrate: Lymphocytes, plasma cells, macrophages in the base and edges; absence of acute neutrophilic response
- Fibrosis & scar formation: Obliterated capillary network; avascular scar tissue impeding healing
- Sentinel pile histology: Oedematous connective tissue, dilated lymphatics, chronic inflammatory cells, squamous epithelium
- Hypertrophied papilla: Fibrous core with squamous surface; occasionally dysplastic cells (rare)
⚠️ Biopsy indications: Atypical location (lateral), irregular/undermined edges, failure to respond to standard treatment, features of Crohn's/malignancy, multiple fissures, immunosuppressed patient
📈 Acute vs Chronic Fissure
| Feature | Acute (<6 wks) | Chronic (>6 wks) |
|---|---|---|
| Edges | Soft, fresh | Indurated, fibrotic |
| Base | Red, granulation | White IAS fibres visible |
| Sentinel pile | Absent | Present |
| Hyp. papilla | Absent | Present |
| Depth | Superficial | Deep to IAS |
| Healing tendency | Often spontaneous | Rarely spontaneous |
| Manometry | Mild ↑ pressure | Significantly ↑↑ pressure |
| Treatment | Conservative | Pharmacological / LIS |
Clinical Features
Symptoms, examination findings, and differential diagnosis
😣 The Symptom Triad
🔥 1. PAIN — The dominant symptom
- Sharp, tearing, or burning pain during defecation
- "Knife-like" or "broken glass" character
- Characteristic pattern: Brief initial pain during stool → 30 min to hours of severe spasmodic pain → gradual subsidence
- Fear of defecation → constipation → perpetuating cycle
- Interferes with daily activities, sitting, walking
🩸 2. BLEEDING
- Bright red blood on paper or surface of stool
- Usually small amount (streaks, not profuse)
- Distinct from haemorrhoidal bleeding (dripping)
- Blood does not mix with stool (vs colorectal cancer)
😰 3. DISCHARGE / PRURITUS
- Mucous or serous discharge from the fissure base
- Perianal pruritus and irritation
- Soiling of underwear; local hygiene difficulty
🔍 Examination Findings
| Finding | Description | Significance |
|---|---|---|
| Sentinel pile | Oedematous skin tag at anal verge (6 o'clock) | Confirms chronicity; pathognomonic |
| Visible fissure | Linear crack with indurated, pale edges; white IAS base | Diagnostic; depth indicates chronicity |
| Hyp. papilla | Enlarged internal tag visible/palpable proximal to fissure | Completes the triad |
| Anal spasm | Tight, hypercontracted anal orifice on gentle separation | Confirms IAS hypertonia |
| DRE | Often not possible due to severe pain and spasm; if done: tight anal canal | High IAS resting tone confirmed |
| Position | Lithotomy: 6 o'clock (posterior); 12 o'clock (anterior) | Midline location confirms primary fissure |
Bidigital assessment (Dr. O.P. Bhandari's technique): Index finger of each hand placed at 3 & 9 o'clock positions on anal verge. Gentle lateral traction reveals fissure without causing excessive pain. Simultaneously assesses IAS tone and fissure extent.
⚖️ Differential Diagnosis
| Condition | Distinguishing Features |
|---|---|
| Haemorrhoids | Painless or mild ache; prolapsing tissue; no linear crack; painless bleeding |
| Perianal abscess | Constant throbbing pain; swelling; fever; no linear fissure seen |
| Fistula in ano | Chronic discharge; external opening; probe-able tract; no crack |
| Crohn's fissure | Atypical/lateral/multiple; irregular edges; associated with Crohn's features; biopsy: granulomas |
| Anal TB | Multiple/irregular; pale granulation; biopsy: caseating granulomas; AFB positive |
| Anal SCC | Irregular, raised everted edges; not healing; biopsy mandatory |
| Syphilis (primary) | Painless ulcer; inguinal LN; VDRL positive; atypical location |
| Herpes simplex | Multiple vesicles/ulcers; herpetiform; acute pain; viral culture positive |
🚩 Red Flag Features — Biopsy Mandatory
Lateral or anterior fissure in males — suspect Crohn's, TB, or malignancy
Multiple simultaneous fissures — Crohn's disease, HIV
Irregular, undermined or raised edges — squamous cell carcinoma
Failure to respond to adequate conservative treatment (12 weeks)
Profuse bleeding disproportionate to fissure size
Immunosuppressed patient — HIV, transplant, chemotherapy
Treatment
Management algorithm — conservative to surgical
🗺️ Management Algorithm
📋 New Patient with Anal Fissure
↓
🔍 History + Examination: Duration, Location, Triad, Atypical features?
↓
✅ Acute (<6 weeks)
Typical location, soft edges
Typical location, soft edges
↓
💊 Conservative 1st Line:
Dietary fibre, sitz baths, stool softeners, topical anaesthetic
Dietary fibre, sitz baths, stool softeners, topical anaesthetic
↓ 4 weeks
No response?
→ Add GTN / Diltiazem
→ Add GTN / Diltiazem
🔴 Chronic (>6 weeks)
Complete triad present
Complete triad present
↓
💊 Pharmacological:
GTN 0.2% or Diltiazem 2% (8 weeks)
GTN 0.2% or Diltiazem 2% (8 weeks)
↓ 8 weeks
Persistent?
→ Botulinum Toxin
→ Botulinum Toxin
↓
⚔️ SURGERY: Lateral Internal Sphincterotomy (LIS)
Failed medical treatment | Recurrent fissure | Patient preference | Complete triad
Failed medical treatment | Recurrent fissure | Patient preference | Complete triad
🌿 Conservative Management
| Treatment | Details | Efficacy |
|---|---|---|
| High-fibre diet | 20–30g fibre/day; 6–8 glasses water | Essential baseline |
| Sitz baths | Warm water 2–3× daily; relaxes IAS, improves blood flow | Symptom relief |
| Stool softeners | Ispaghula, lactulose, docusate sodium | Prevents recurrence |
| Topical anaesthetic | Lignocaine 5% gel before defecation | Pain relief only |
💊 Pharmacological Treatment
| Drug | Dose & Route | Efficacy | Side Effects |
|---|---|---|---|
| GTN 0.2% | Applied to anal margin TDS × 8 wks | 50–70% healing | Headache 25–30%, tachyphylaxis |
| Diltiazem 2% | Topical BD × 8 wks; or 60mg oral BD | 60–65% healing | Minimal; pruritus |
| Nifedipine 0.2% | Topical TDS | ~60% | Headache, palpitation |
| Botulinum Toxin A | 20–30 units each side of IAS | 60–80% | Temporary incontinence (1–5%) |
⚔️ Indications for Surgery (LIS)
- Chronic fissure not responding to medical treatment after 8–12 weeks of adequate pharmacological therapy
- Complete triad present (ulcer + sentinel pile + hypertrophied papilla)
- Recurrent fissure after previous medical treatment
- Patient preference for definitive treatment (especially when occupation/lifestyle is affected)
- Fissure associated with symptomatic haemorrhoids requiring surgery
- Anal stenosis complicating chronic fissure
Contraindications to LIS: Pre-existing incontinence, Crohn's disease, previous sphincter injury/surgery, low IAS pressure on manometry, atypical fissure pending biopsy
📊 Comparison of Treatment Options
| Treatment | Healing Rate | Recurrence | Incontinence |
|---|---|---|---|
| Conservative only | 40–50% | High | 0% |
| GTN topical | 50–70% | 30–50% | 0% |
| Diltiazem | 60–65% | 30–45% | 0% |
| Botulinum Toxin | 60–80% | 20–30% | 1–5% (transient) |
| LIS (Open) | 95–98% | 1–2% | 0.5–5% |
| LIS (Closed/blind) | 92–96% | 2–5% | 5–15% |
| Dr. Bhandari's Modified LIS | ~98% | <1% | 0% |
Surgical Technique
Dr. O.P. Bhandari's 11-step Modified Open Lateral Internal Sphincterotomy
🎯 Principle: Divide a precise, measured portion of the distal IAS (not more than the depth of the fissure, not crossing the dentate line) to reduce resting pressure below the ischaemic threshold while preserving continence. Bidigital assessment guides extent of division.
🩺 Pre-operative Assessment
- Complete history: duration, prior treatments, continence status
- Bidigital examination: assess IAS tone, fissure extent, presence of triad
- Rule out atypical features (biopsy if indicated)
- Exclude pre-existing incontinence (absolute contraindication)
- Proctoscopy when spasm allows — assess for haemorrhoids, polyps
- Routine blood work; fitness for anaesthesia (spinal preferred)
- Informed consent: risk of incontinence (transient, rare), recurrence, bleeding, infection
- Bowel prep: phosphate enema 2h pre-op (optional)
🛏️ Setup & Positioning
| Parameter | Details |
|---|---|
| Position | Lithotomy (preferred) — full access, assistant access, video view |
| Anaesthesia | Spinal (preferred) or GA; local infiltration at incision site |
| Instruments | Proctoscope, Park's retractor, small Langenbeck's, fine artery forceps, size 15 blade, fine scissors, 3-0 Vicryl |
| Side of LIS | Left lateral (3 o'clock) — away from fissure (6 o'clock) |
| Lighting | Headlight + video camera for teaching |
📋 The 11-Step Modified Open LIS
1
Bidigital Assessment
Index finger of each hand at 3 & 9 o'clock. Measure IAS tone. Assess fissure depth. Define extent of sphincterotomy required. This assessment is repeated after division to confirm adequacy.
2
Sentinel Pile Excision
If symptomatic or large, excise the sentinel skin tag. This unroofs the distal fissure and allows clear visualisation of the IAS. Sent for histopathology.
3
Intersphincteric Groove Identification
Palpate the groove at 3 o'clock position (left lateral). This is the anatomical plane between IAS (inner) and EAS (outer) — the safest approach corridor.
4
Radial Incision
A 0.5–1.0 cm radial incision at 3 o'clock in the intersphincteric groove using size 15 blade. Incision through skin only — not into muscle at this stage.
5
Intersphincteric Dissection
Fine artery forceps gently dissect in the intersphincteric plane. The white, shiny IAS is identified and separated from the overlying anoderm/mucosa. This is the key step — stay in the correct plane.
6
IAS Delivery / Herniation
Gently deliver (herniate) the IAS through the incision using forceps. The white, firm, circular muscle bundles of the IAS are now clearly visible. Direct visualisation is the hallmark of the OPEN technique — prevents over-division or injury to EAS.
7
Measured Division of IAS
Using fine scissors or electrocautery, divide the IAS precisely to the level of the dentate line — not above it. The extent equals the fissure depth. Division is confirmed by visibly seeing the cut edges spring apart. Bidigital check confirms adequate relaxation.
8
Haemostasis
Meticulous haemostasis with bipolar cautery or ligature. The critical vessel is a small branch of the inferior rectal artery at the IAS cut edge — secure this to prevent delayed haemorrhage.
9
Hypertrophied Papilla Excision
Excise the internal hypertrophied papilla if present and symptomatic. Avoids future prolapse symptoms. Sent for histopathology. This completes resolution of all three components of the triad.
10
Upper Mucosal Flap Mobilisation (if fissure is wide enough)
If the fissure is wide enough, the upper mucosal flap is mobilised and sutured to the anoderm at the anal verge using 3-0 Vicryl mattress sutures. This advances healthy vascularised mucosa over the fissure base, accelerates healing, and reduces the risk of delayed wound breakdown or stenosis.
11
Wound Closure & Post-op Care
LIS wound left open or loosely closed with 3-0 Vicryl. Fissure site curettage of unhealthy granulation tissue (optional). Dressing. Sitz baths from day 1. Discharge same or next day. Stool softeners for 4 weeks.
🛑 Special Situations
Anal Stenosis with Fissure: Perform LIS + ano-cutaneous advancement flap if stenosis is significant. The V-Y or house flap advances skin to widen the anal canal simultaneously.
Intraoperative Bleeding: Usually from inferior rectal artery branches. Apply direct pressure → bipolar coagulation → suture ligation if needed. Never use blind packing in the intersphincteric space.
Fissure with Haemorrhoids: Perform LIS first → assess haemorrhoidal plexus → selective haemorrhoidectomy if Grade III-IV haemorrhoids present. Avoid extensive dissection in one sitting.
⚠️ Complication Management
| Complication | Rate | Management |
|---|---|---|
| Incontinence (flatus) | 0–3% | Conservative; usually resolves 6–8 weeks; biofeedback |
| Incontinence (solid/liquid) | <1% | Rare; sphincter repair if persistent |
| Haemorrhage | 1–2% | Haemostasis; return to OT if pulsatile |
| Infection/abscess | <1% | Drainage; antibiotics; wound care |
| Fissure recurrence | 1–3% | Re-assess; repeat LIS or extension |
| Fistula formation | <0.5% | Fistulotomy when tract defined |
Dr. Bhandari's series: 153 cases, 8 years — 0% incontinence, attributed to direct visualisation of IAS, measured division, bidigital assessment, and avoiding dentate line crossing.
Outcomes & Results
Dr. Bhandari's personal series vs published literature
153
Total Cases in Series
8
years
Duration of Series
0%
Incontinence Rate
~98%
Healing Rate
<1%
Recurrence Rate
Day 1
Discharge (most patients)
📈 Series Outcomes in Detail
| Outcome Measure | Dr. Bhandari's Series |
|---|---|
| Total patients | 153 |
| Male : Female | ~2:1 |
| Mean age | 35–45 years |
| Posterior fissures | ~90% |
| Complete triad present | ~85% |
| Prior conservative treatment failed | 100% |
| Anaesthesia used | Spinal (majority) |
| Day case / next-day discharge | ~95% |
| Healing at 6 weeks | ~98% |
| Pain-free at 1 week | ~90% |
| Incontinence (any grade) | 0 / 153 (0%) |
| Recurrence (follow-up 1–8 years) | <1% |
| Re-operation required | <1% |
| Histopathology (sentinel pile/papilla) | All benign; no malignancy |
📚 Comparison with Published Literature
| Study / Series | Healing | Recurrence | Incontinence |
|---|---|---|---|
| Dr. Bhandari (Modified Open LIS) | ~98% | <1% | 0% |
| Hananel & Gordon (1997) — Open LIS | 97% | 2% | 0–3% |
| Littlejohn & Newstead — Closed LIS | 94% | 4% | 5–12% |
| Khubchandani & Reed — Closed LIS | 95% | 3% | 8–30% |
| Botulinum Toxin (meta-analysis) | 70% | 20% | 1–5% (transient) |
| GTN 0.2% (meta-analysis) | 58% | 30–50% | 0% |
| Diltiazem (meta-analysis) | 63% | 30–45% | 0% |
Key differentiator: The 0% incontinence rate in Dr. Bhandari's series vs 5–30% in closed LIS series is attributed to the direct visualisation, measured division, and bidigital assessment of the open technique — preventing inadvertent EAS injury.
🗣️ Patient Counselling Points
- Surgery is day-case / 1-night stay; return to normal activity in 3–5 days
- Expect some discomfort for 1–2 weeks; significantly less than pre-operative fissure pain
- Pain-free defecation typically within 1 week post-operatively
- Maintain high-fibre diet and hydration lifelong to prevent constipation recurrence
- Sitz baths twice daily for 4 weeks; keep area clean and dry
- Wound typically heals within 4–8 weeks; follow-up at 2 and 6 weeks
- Incontinence risk is extremely low (<1%) with proper technique; temporary if occurs
- Recurrence rare (<1%); maintain bowel habits to prevent
Videos, Certificates & Resources
Operative videos, awards, and contact
🎥 Operative Videos — YouTube
▶️
Dr. Om Prakash Bhandari — Official YouTube Channel
Full channel with surgical demonstrations, patient education content, and CME videos on colorectal procedures including Modified Open LIS for Chronic Fissure in Ano.
🔴 YouTube Channel@DrOmPrakashBHANDARI
🎬
Operative Video 1 — Modified Open LIS
Step-by-step operative demonstration of the 11-step Modified Open Lateral Internal Sphincterotomy. Bidigital assessment, intersphincteric dissection, IAS delivery, measured division, and mucosal flap technique clearly demonstrated.
▶ Watch on YouTubeStep-by-StepLIS Technique
📹
Operative Video 2 — Bidigital Assessment & Technique
Advanced video covering the bidigital assessment technique, how to handle intraoperative bleeding, special situations (anal stenosis, concurrent haemorrhoids), and post-operative care instructions.
▶ Watch on YouTubeAdvanced TechniqueComplications
🏆 Awards & Certifications
ACRSICON 2024 — Certificate I
Association of Colon and Rectal Surgeons of India Annual Conference 2024. Recognition for presentation / contribution in the field of colorectal surgery. Dr. Bhandari's work on Modified Open LIS outcomes presented at this national platform.
ACRSICON 2024National Conference
ACRSICON 2024 — Certificate II
Second certification from ACRSICON 2024 for academic excellence and contributions to colorectal surgical education and research in India. Recognises the 8-year personal series data on chronic fissure outcomes.
ACRSICON 2024Academic Excellence
📍 Location & Contact
📌 Dr. Bhandari Piles Hospital, Chittorgarh
Located in Chittorgarh, Rajasthan. For appointments, referrals, and surgical consultations for chronic fissure in ano and other colorectal conditions.
🗺️ Open on Google Maps👨⚕️ Name: Dr. O.P. Bhandari
🎓 Qualifications: MBBS; MS (General Surgery); FAIS
🏫 Ex Professor of Surgery: PIMS Udaipur
🏥 Consultant: Dr. Bhandari Piles Hospital, Chittorgarh
🏥 Hon. Consultant: MP Birla Hospital, Chittorgarh
📅 Experience: 8+ years, 153+ LIS cases
🏆 Recognition: ACRSICON 2024 × 2
📞 Mobile: 8764001124 | 9461521485
☎️ Clinic: 01472 241544
▶️ YouTube: @DrOmPrakashBHANDARI
📖 Further Reading & References
- ⭐ Landmark Paper — Hoffmann DC & Goligher JC. Lateral subcutaneous internal sphincterotomy in treatment of anal fissure. Br Med J. 1970;3(5724):673–675. PMID: 5470113
- Bennett RC & Goligher JC. Results of internal sphincterotomy for anal fissure. Br Med J. 1962;2(5318):1500–1503
- Watts JM, Bennett RC & Goligher JC. Stretching of anal sphincters in treatment of fissure-in-ano. Br Med J. 1964;2(5405):342–343
- Hananel N, Gordon PH. Re-examination of clinical manifestations and response to therapy of fissure-in-ano. Dis Colon Rectum. 1997;40:229–233
- Poh A, Tan KY, Seow-Choen F. Innovations in chronic anal fissure treatment: A systematic review. World J Gastrointest Surg. 2010
- Nelson RL, Thomas K, Morgan J, Jones A. Non-surgical therapy for anal fissure. Cochrane Database Syst Rev. 2012
- Mapel DW et al. The epidemiology and treatment of anal fissures in a population-based cohort. BMC Gastroenterol. 2014
- Mentes BB et al. Extent of lateral internal sphincterotomy: up to the dentate line or controlled? Dis Colon Rectum. 2011;54:837–842
- American Society of Colon and Rectal Surgeons (ASCRS) — Practice Parameters for the Management of Anal Fissures. 2023
- Association of Colon and Rectal Surgeons of India (ACRSICON) — Guidelines 2024
🩺
Dr. O.P. Bhandari's Surgical Philosophy
"The open technique, with direct visualisation and bidigital assessment, removes the guesswork from sphincterotomy. When you can see what you are dividing, and confirm adequacy with your fingers, you achieve the perfect balance between efficacy and safety — a healed fissure and a continent patient."
Modified Open LIS0% Incontinence~98% HealingACRSICON 2024