Inclusion Criteria:  age 18-85 years Must have anal pain during bowel movements Must have acute posterior anal fissure Must have candidacy for surgery after failure of conservative treatment, or recurrence of the problem.  Exclusion Criteria:  Concomitant anal pathology (anorectal fistulae,abscesses). Previous surgery on the pelvic floor. Inflammatory bowel disease Inability to sign consent to participate in the study Pregnancy