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    Open or closed lateral internal sphincterotomy, excision , excision and Y-V or other anoplasty, or anal dilation. A chronic anal fissure can be identified by the presence of a sentinel pile , anal ulcer , and a hypertrophied anal papilla arising from the dentate line. • External hemorrhoids originate distal to the dentate line of the anus and are covered by squamous epithelium.

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