الفهرس 
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Abstract
This study compare using of non surgical methosds included botulinum toxin injection and glyceryl tri nitrate 0.2% with surgical methods included fisserectomy with lateral internal sphinctrotomy in treatment of chronic anal fissure we found that using of surgical methods give results equal 100% after six month follow up while using of glycerial trinitrate 0.2% twice per day for 8 weeks the result was 70% healing rate while it was 75% in botulinum toxin injection we inject 20 unit of botulinum toxin in internal anal sphincter anterior after dilution of it in 50u saline .The complication was insignificant in three groups , incontinence was to flatus only and it disappear after three months follow up , we recommended using of lateral internal sphinctertomy as frist line in treatment of chronic anal fissure and using of chemical sphincterotomy in patient who unfit for surgery or refusing surgery.
Key wards :
Chronic-anal- fissure- surgical-botulinum