Fig. 1

Diagnostic and therapeutic algorithm for typical anal fissure. *According with the low grade of evidence supporting the preoperative morphological and functional investigations, the choice to perform both endoanal ultrasound and anal manometry should be considered optional in the clinical practice. Therefore, the evaluation of the anal tone may be carried out by digital examination and the detection of an associated local sepsis may be performed during surgery. **The choice to perform an anocutaneous flap may be based on surgeon preference and on intraoperative findings. Particularly, the addition of a flap should be carefully considered in presence of gross local infection. In these cases an isolated fissurectomy should be reasonably preferred