Name of the Procedure:

Sphincterotomy, Anal, Division of Sphincter
Common name: Anal Sphincterotomy

Summary

An anal sphincterotomy is a surgical procedure performed to treat chronic anal fissures. This operation involves cutting a small portion of the anal sphincter muscle to reduce spasm and pressure, facilitating healing.

Purpose

The primary goal of an anal sphincterotomy is to relieve pain and promote healing of chronic anal fissures that have not responded to conservative treatments. By decreasing the tightness of the sphincter muscle, the procedure helps alleviate symptoms like severe pain during bowel movements and bleeding.

Indications

• Chronic anal fissures that persist for over 6-8 weeks.
• Severe pain during and after bowel movements.
• Recurrent fissures despite medical therapy.
• Fissures associated with hypertonic (tight) anal sphincter muscles.

Preparation

• Patients may be advised to fast for several hours before the procedure.
• Medication adjustments, such as stopping blood thinners, may be necessary.
• Pre-operative assessments might include blood tests and an evaluation of the patient’s overall health.

Procedure Description

1. Anesthesia: The procedure is typically performed under local, regional, or general anesthesia.
2. Positioning: The patient is positioned to allow optimal access to the anal region.
3. Incision: A small incision is made in the anal mucosa.
4. Division: A portion of the internal anal sphincter muscle is carefully divided.
5. Closure: The incision is usually left open to heal naturally or closed with sutures.

Specialized surgical tools, such as scalpels and retractors, are used during the procedure.

Duration

The procedure usually takes about 20 to 30 minutes.

Setting

An anal sphincterotomy is typically performed in a hospital or an outpatient surgical center.

Personnel

• Surgeon specialized in colorectal surgery.
• Anesthesiologist/Nurse anesthetist
• Operating room nurses and surgical technologists

Risks and Complications

• Common risks: Infection, pain, mild bleeding.
• Rare risks: Incontinence, recurrence of fissures, abscess formation.

Benefits

• Significant pain relief.
• High success rate for the healing of chronic anal fissures.
• Improved quality of life within a few weeks post-surgery.

Recovery

• Patients can often go home the same day.
• Pain management with prescribed medications.
• Sitz baths to promote healing and comfort.
• Avoid strenuous activities for a few weeks.
• Follow-up appointments to monitor healing.

Alternatives

• Topical treatments: Nitroglycerin ointment, diltiazem, or nifedipine creams.
• Botulinum toxin (Botox) injections: To temporarily paralyze the sphincter muscle.
• Dilation: Manual stretching of the sphincter (less common).

Patient Experience

During the procedure, patients will be under anesthesia and should feel no discomfort. Post-procedure, they may experience some pain and discomfort, manageable with medications. Warm sitz baths and avoiding strenuous activities help ease recovery. Constipation should be avoided using dietary adjustments and/or stool softeners.