46750 Sphincteroplasty, anal, for incontinence or prolapse; adult

Name of the Procedure:

Sphincteroplasty, Anal (for Incontinence or Prolapse), Adult

Summary

Sphincteroplasty is a surgical procedure to repair and strengthen the anal sphincter muscles. It's typically used to treat adults experiencing anal incontinence or prolapse.

Purpose

Sphincteroplasty addresses the weakness or damage in the anal sphincter muscles, aiming to restore normal bowel control and improve quality of life. The expected outcome is reduced incontinence and enhanced control over bowel movements.

Indications

• Severe anal incontinence (inability to control bowel movements).
• Anal prolapse (where the rectum protrudes through the anus).
• Damage to the sphincter muscles due to childbirth, trauma, or surgery.
• Patients who have not responded to conservative treatments like dietary changes or physical therapy.

Preparation

• Pre-procedure fasting (usually no eating or drinking after midnight before the procedure).
• Possible adjustments to medications (e.g., blood thinners).
• Preoperative consultation including a medical history review and physical examination.
• Necessary diagnostic tests, such as anorectal manometry, endoanal ultrasound, or MRI, to assess the extent of sphincter damage.

Procedure Description

1. The patient is placed under general anesthesia or regional anesthesia with sedation.
2. An incision is made around the area of the damaged sphincter.
3. The surgeon identifies and isolates the damaged sphincter muscles.
4. The muscles are surgically repaired and overlapped to strengthen the sphincter.
5. The incision is closed with sutures.
6. A dressing is applied to the surgical site to protect it as it heals.

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

Sphincteroplasty is performed in a hospital or surgical center.

Personnel

• Surgeon (usually a colorectal specialist).
• Anesthesiologist or nurse anesthetist.
• Surgical nurses or assistants.

Risks and Complications

• Common risks: Infection, bleeding, pain at the surgical site.
• Rare risks: Nerve damage, recurrence of incontinence or prolapse, prolonged or chronic pain, anal stricture.
• Complications are managed with medications, additional procedures, or physical therapy as necessary.

Benefits

• Improved bowel control.
• Reduction or elimination of fecal incontinence.
• Increased quality of life and confidence. Improvements may be noticed within weeks to a few months after surgery.

Recovery

• Patients may need to stay in the hospital for 1-2 days.
• Pain is managed with medications.
• Advised to avoid strenuous activities for several weeks.
• Limited to a soft diet initially, gradually returning to normal eating habits.
• Follow-up appointments are necessary to monitor healing and function.

Alternatives

• Non-surgical treatments: dietary management, fiber supplements, pelvic floor exercises, biofeedback.
• Other surgical options: sacral nerve stimulation, artificial bowel sphincter.
• Pros and cons vary; nonsurgical options have lower risk but may be less effective in severe cases, while alternative surgeries have different risk profiles and effectiveness.

Patient Experience

• during the procedure, the patient will be under anesthesia, so will not feel or remember the surgery.
• Post-procedure pain is expected and managed with analgesics.
• Patients may experience initial discomfort, but this improves as healing progresses.
• Supportive care, including instructions on gentle bowel management and hygiene, will be provided to ensure comfort and promote recovery.