Proper and hygiene is important in both prevention and initial conservative management of symptomatic anal fissures. For chronic intractable cases, open lateral internal sphincterotomy is strongly recommended. C-anoplasty should be done when strictures are present. Excision of the protruding internal sphincter is recommended in patients who present with an excessively elongated, tight anal canal with a partially protruding internal sphincter.

Twelve patients with anatomic anal stricture were treated with C-anoplasty in the past six years. Anal stricture was caused by previous hemorrhoidectomy in ten, fistulectomy in one, and fissurectomy in one. All patients had had conservative treatment from four to 22 years but failed to respond. Eleven patients obtained satisfactory results from C-anoplasty; one required three anal dilatations postoperatively because of restricture. C-anoplasty is advantageous because it extends the pedicle without compromising vascular supplies; suture-line tension can be controlled by extending the incision; and the size of the graft is easily adjustable to anal size.