الفهرس 
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Abstract
Anal fissure is a common disorder which affects all age groups and sexes. It has a major impact on patients’ quality of life. In this study, we compared two techniques in the treatment of chronic anal fistula (unilateral botox injection & tailored sphincterotomy). Seventy patients were included to this study. Patients were subjected to preoperative assessment which included careful history taking, meticulous clinical examination, anorectal manometry. Patients were randomly divided into two equal groups. There were no significant differences between the two groups regarding age, gender of patients and presenting symptoms. group 1 was subjected to unilateral botox injection. group 2 was subjected to tailored sphincterotomy. Patients were followed up in Mansoura University Out-patient Clinic. The patients were schedueled for follow-up at 1 week, 4 weeks, 12 weeks, and 24 weeks after the surgery. During each visit, complete assessment of the patient was done including assessment of healing, pain, recurrence and anal sphincter dysfunction ( incontinence ). After collection and analyzing these data, we found that duration of healing of wound Duration of healing in group A was 8.43 ± 1.70 , significantly (p< 0.001) shorter than group B20.83 ± 2.20 . Furthermore, pain relief was significantly better in group A than other group B. On follow-up, 10 (28.5%) patients in group A and 5 (14.2%) patient in group B experienced recurrence of anal fissure. Incontinent to flatus in group A 9 (25.7%) , group B 5 (14.2%) significantly (p< 0.122) & Incontinent to solid stool in group A 2 (5.7%) , group B 0 (0%) significantly (p< 0.039). Flatus incontinence that was recorded in group B was of minor grade and showed improvement with biofeedback therapy.