45905 Dilation of anal sphincter (separate procedure) under anesthesia other than local

Name of the Procedure:

Dilation of Anal Sphincter
(Common names: Anal Sphincter Dilation, Anal Dilatation; Medical term: Sphincterotomy by Dilation)

Summary:

This procedure involves widening the anal sphincter muscle under anesthesia to relieve pain or obstruction in the anal region. It is performed under general or regional anesthesia other than local.

Purpose:

The primary goal is to alleviate discomfort or obstruction caused by conditions like anal fissures, strictures, or scarring. It aims to improve bowel movement and reduce pain associated with tightness in the anal sphincter.

Indications:

• Chronic anal fissures that do not respond to other treatments
• Anal stricture or stenosis
• Persistent pain in the anal region
• Complications following hemorrhoid surgery

Preparation:

• Fasting for at least 6-8 hours before the procedure
• Adjusting or pausing certain medications as advised by the doctor
• A pre-procedure consultation including a physical examination and potentially a colonoscopy or anoscopy

Procedure Description:

1. Administering general or spinal anesthesia to ensure the patient is unconscious or numb from the waist down.
2. The patient is positioned to allow easy access to the anal region.
3. The surgeon uses a series of dilators of increasing size to gently widen the anal sphincter.
4. The procedure may also involve the use of lubricants and special surgical tools.
5. The process is done gradually to avoid excessive tearing or damage to the tissue.

Duration:

Typically, the procedure takes about 20-30 minutes, excluding anesthesia preparation and recovery time.

Setting:

The procedure is usually performed in a hospital or an outpatient surgical center equipped for such operations.

Personnel:

• Surgeon
• Anesthesiologist
• Surgical nurse
• Operating room technician

Risks and Complications:

• Pain or discomfort in the anal area post-procedure
• Risk of bleeding or infection
• Possible damage to the anal sphincter leading to incontinence
• Rare complications like deep tissue infection or severe scarring

Benefits:

• Relief from pain and discomfort caused by tight anal sphincter
• Improved bowel movements and reduced constipation
• Enhanced quality of life due to reduced symptoms

Recovery:

• Patients may experience mild to moderate pain, which can be managed with prescribed painkillers.
• Avoiding strenuous activities and heavy lifting for a few days
• Maintaining good hygiene and using sitz baths for comfort
• Follow-up appointments to monitor healing and progress
• Full recovery typically takes a few weeks

Alternatives:

• Medication management with topical anesthetics or nitroglycerin ointment
• Botulinum toxin (Botox) injections to relax the sphincter
• Surgical options like lateral internal sphincterotomy
• Pros of alternatives: Less invasive, less recovery time
• Cons of alternatives: May not be as effective, potential need for repeat treatments

Patient Experience:

• Patients will not feel the procedure due to anesthesia; however, they may experience some initial discomfort once the anesthesia wears off.
• Post-procedure, pain management includes medications and sitz baths.
• The patient can expect gradual relief from symptoms within a few days to weeks, with significant improvement in quality of life.