title: Manual dilatation of the anus-still widely practised in the West of Scotland.
abstract: OBJECTIVE
  Two main surgical options exist for the current treatment of chronic anal fissure: manual dilatation of the anus (MDA) and lateral internal sphincterotomy (LIS). The high incidence of incontinence after MDA is widely documented. One study carried out in the West of Scotland in 1992 showed that 49% of patients undergoing MDA subsequently suffered some degree of incontinence. This study was set up to determine the number of surgeons in the region who continue to use MDA in their clinical management of chronic anal fissure.
  
  
  METHODS
  All consultant and higher surgical trainees in General Surgery in the West of Scotland were circulated with a postal questionnaire in November 1996 requesting how long they had been in post and to state their current preferred treatment of choice for chronic anal fissure.
  
  
  RESULTS
  Almost half the consultant surgeons (47%) in the West of Scotland favour MDA as their treatment of choice and its utilization increases according to seniority. In contrast, registrars and junior consultants predominantly use LIS.
  
  
  CONCLUSIONS
  These data show a high incidence of MDA as the treatment of choice for chronic anal fissure amongst consultant surgeons in the West of Scotland. The implications of such a practice are discussed.
authors.affiliation: Division of Surgery, Stobhill NHS Trust, UK Department of Coloproctology, Royal Infirmary, Glasgow, UK.
authors.lastname: Coull
authors.lastname: McCourtney
authors.lastname: Finlay
authors.lastname: Dalling