This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
[{'content': 'All are the treatment of acute fissure in ano except one - \nSelect and explain. \nA. Conservative, B. Dilatation under GA, C. Lateral sphincterotomy, D. External sphincterotomy', 'role': 'user'}, {'content': 'Answer: D \nExplanation: Treatment of Anal fissure\nThe object of all t/t is to obtain complete relaxation of the internal sphincter.\nConservative t/t\n\nStool bulking agents and stool softeners.\nNitric oxide or Glyceryl trinitrate is applied as an ointment to the anal canal produce sufficient relaxation of the sphincter to allow the fissure to heal up in 2/3 of pts. (k/a chemical Sphincterotomy).\n\n\n\nDilatation of the sphincter under GA\nLateral anal sphincterotomy - the internal sphincter is divided away from the fissure itself - usually either in the right or the left lateral position.\nAnal advancement flap - this operation consists of excision of the edges of the fissure and mobilization of a square, full thickness anal skin flap so that this can be slid forward over the fissure and sutured in place. This technique has become popular recently as there is little risk of damage to the underlying internal sphincter and incontinence is unlikely.\n\nA fissure in Ano (or Anal fissure) \n\nA most common site is → mid-line posteriorly.\nMC symptom is → pain associated with defecation.\nFissure starts proximally at the dentate line. So the whole of anal fissure lies in the pain-sensitive part of the anal canal.\nThe bleeding of anal fissure occurs as streaks on the outside of the stool or spots noted on toilet paper.\nThere are 2 types of fissures - Acute & Chronic.\n\nChronic fissure\n\nIs a deep canoe-shaped ulcer with thick edematous margins.\nAt the upper end, there is hypertrophied papilla.\nAt the lower end there is a skin tag k/a sentinel pile.', 'role': 'assistant'}]