Dear Dr.Alawad,

MAD or Lord's dilatation was a popular treatment for acute fissure-in-ano for many years. But now it has been discontinued - and replaced by a more controlled partial internal sphincterotomy. MAD was always uncontrolled and could lead to vaso-vagal shock & incontinence

I would agree un-controlled anal dilatation is not current practice and idea discouraged

I agree with Dr Muthukumar that Lord's procedure was  very popular in mid and and late 70's.It's popularity waned off due to incontinence.By and large present practice is sub cutanious lateral sphicterotomy.

Anal dilatation for the treatment of acute or chronic anal fissure is abondened. The tratment for acute anal fissure should be medical,

Some cases of acute anal fissures can be managed conservatively. For a high number of chronic fissures, conservative management may fail. Lateral sphincterotomy has replaced Anal dilatation in these cases. The failure rate is lower. Though associated with possibility of incontinence, this is usually mild and for a short duration.

I have no experience with anal dilatation for ACUTE ANAL FISSURE, but I see no sense in strectching the sphincteres for such disease. In our country (Brasil)  it's not used at all. The conservative management for superficial fissures has high success rate. Our surgical approach is lateral sphincterotomy associated with curetter and cauterize the bed of the fissure.

Yes, I know this technic and I performed in some cases 15 years ago, but now I prefer to perform lateral sphincterotomy with anoplasic posterior and success rate is good...

ACUTE FISSURE IS GENERALLY TREATED CONSERVATIVELY.

MAD IS NOT DONE ANY MORE, EITHER IN ACUTE OR CHRONIC SITUATION.

Anal fissures can be managed well by Ayurvedic treatments. The treatment includes enema with medicated oils, sitz bath with medicated waters and some local applications. Laxatives are given as a supportive measure. Success rate is very high and no complications occur.

Of course in chronic situation.... 

I THINK THAT NO PLACE FOR MAD IN MODERN SURGICAL PRACTICE...USAGE OF TOPICAL NG OR NEFIDIPINE WILL GIVE GOOD RESULTS IN ADDITION TO SALTY WARM BATHS AND STOOL SOFTENERS, TOPICAL LIDOCAINE CAN BE ADDED

The role of anal dilatation is probably obsolete due to the inherent risk of sphincter injury .When the fissure has been unresponsive to non-operative  management(diet,bulking agents,chemical sphincterotomy), or  has been present from a long time or when the fissure recurs after non operative management, an operative approach is indicated.

It should be strongly discouraged.