Sphincterotomy - Diagnosis, Procedure & Recovery

Sphincterotomy, a surgical procedure aimed at alleviating chronic anal conditions such as fissures. By making an incision into the anal sphincter muscle, sphincterotomy reduces tension and facilitates healing. If you're suffering from this condition, with no relief from conservative treatments, consult with the expert proctologists at Pristyn Care. Fill in the form or call the number mentioned on this page to book your appointment with our expert anorectal surgeon for a sphincterectomy.

Sphincterotomy, a surgical procedure aimed at alleviating chronic anal conditions such as fissures. ... Read More

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What Is Sphincterotomy?

Sphincterotomy is a surgical procedure to treat conditions such as chronic anal fissures. These fissures can cause significant pain during bowel movements due to excessive tension in the anal sphincter muscle. A sphincterotomy involves an incision into this muscle, which helps reduce this tension and promotes the healing of fissures.

Performed by a skilled proctologist, sphincterotomy is typically an outpatient procedure, allowing patients to return home on the same day.

The process is designed for patients who haven’t responded adequately to conservative treatments for anal fissures. The procedure not only eases discomfort but also enhances the blood flow in the affected area, aiding in quicker recovery. Sphincterotomy has a high success rate and low complications. This makes it an effective treatment methodology for chronic anal fissures.

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What Are the Types of Sphincterotomy?

Understanding the various types of sphincterotomy can provide you with a clearer insight into your treatment options. Below are two main approaches to performing a sphincterotomy:

Open Lateral Internal Sphincterotomy
- In this technique, an incision is made in the skin near the anal area to access the internal sphincter muscle.
- The muscle is then cut to relieve pressure and facilitate healing.
Closed Lateral Internal Sphincterotomy
- This technique doesn’t require an external incision.
- Instead, a scalpel is introduced into the groove between the internal and external sphincter muscles.
- From here, the internal sphincter is divided from within.

Both of these procedures aim at alleviating spasms and tension in the anal sphincter. This helps to improve blood flow and promote healing of the fissure. Alternative procedures for sphincterotomy include fissurectomy and botulinum toxin injections. Fissurectomy involves removing the surface layer of the fissure to promote healing. Botulinum toxin injections temporarily relax the sphincter muscle, reducing spasms and facilitating recovery.

Diagnosis Before Sphincterotomy

Before proceeding with a sphincterotomy, the doctor will diagnose the condition of chronic anal fissures. Several methods are employed to accurately determine the presence of this ailment:

Symptomatic Analysis: The patient usually experiences intense pain during and for a couple of hours after bowel movements. The presence of bright red blood during or after defecation is another indicator. A history of recurrent fissures persisting for over six weeks also signifies chronicity.
Physical Examination: The doctor confirms diagnosis through direct inspection of the fissure, often located in the midline, either anteriorly or posteriorly. Chronic fissures typically display visible sphincter fibres at the base. It also shows the presence of anal papillae, or sentinel piles, and indurated margins around the fissure.
Lateral Traction Application: Lateral traction application improves fissure visualisation by gently pulling the tissue aside. This allows for more precise and effective treatment.
Evaluation for Other Conditions: If the fissure appears off the midline or seems atypical, further examination is necessary. This is done to check for underlying conditions such as inflammatory bowel disease, sexually transmitted infections, or malignancies.

What Is the Procedure for Sphincterotomy?

A sphincterotomy is a surgical procedure that is performed to treat chronic anal fissures. Here are the steps involved:

Anaesthesia Administration: Local anaesthesia is given to numb the area to avoid discomfort during the surgery.
Incision: A radial incision is made over the intersphincteric groove in the left lateral position through the anoderm for open sphincterotomy. For a closed sphincterotomy, a scalpel is used to divide the internal sphincter from within.
Elevation and Division: In an open sphincterotomy, once the incision is made, the internal anal sphincter is elevated off the external sphincter using a hemostat. It is then divided either sharply or with electrocautery up to the dentate line.

The goal of both techniques is to minimise spasms and tension in the anal sphincter. This helps to increase blood flow and aid in fissure healing.

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Who Is the Right Candidate for Sphincterotomy?

An individual’s eligibility for the sphincterotomy procedure is determined by several factors:

Chronicity of Fissures: Individuals with a history of persistent fissures are considered potential candidates if the fissures have resisted conservative treatment. This evaluation typically occurs after at least six weeks of unsuccessful conservative management.
Health Conditions: Individuals with underlying conditions causing atypical or multiple fissures, such as inflammatory bowel disease or infections, require further evaluation. This ensures the most appropriate treatment approach is chosen.
Failed Conservative Management: The procedure is generally recommended for patients whose condition has not improved despite conservative management strategies.
Impact on Quality of Life: Potential candidates usually have significant discomfort during routine activities like bowel movements due to chronic anal fissures.

What Are the Benefits of Sphincterotomy?

A sphincterotomy, especially the lateral internal variety, is a surgical procedure that brings several benefits to patients suffering from chronic anal fissures. Here’s how it can help:

Effective relief from pain: This operation significantly reduces the intense pain associated with anal fissures. It works by relieving muscle tension and spasms in the anal sphincter.
Promotes healing: Sphincterotomy boosts blood flow and decreases pressure in the anal area. This improves the healing of chronic fissures that have not responded to other treatment methods.
High success rate: With a 95% success rate, this procedure is a reliable option for those with persistent symptoms.
Outpatient procedure: Generally, sphincterotomy is performed at an OPD (outpatient department), which means patients can return home on the same day.

How to Prepare for a Sphincterotomy?

Before going through with a sphincterotomy, there are certain steps you, as a patient, need to follow:

Consultation: Discuss with your surgeon about the operation, anaesthesia options, and any lingering concerns you might have.
Medication adjustments: You may need to halt using blood thinners or anti-inflammatory medicines several days before surgery. This helps in minimizing bleeding risks.
Bowel preparation: While bowel prep is usually not required, your surgeon may instruct you otherwise.
Transportation: Since anaesthesia can tamper with your ability to drive safely, you should arrange for a ride home post-operation.

What Are the Recovery Tips and Precautions to Follow After Sphincterotomy?

After undergoing a sphincterotomy, certain steps aid in healing and minimize discomfort:

Rest and gradual activity: Initially, plenty of rest is essential. As you recuperate, start including light activities, like a short walk, in your daily routine.
Sitz baths: To soothe the area, have warm sitz baths three times daily and after bowel movements.
Dietary considerations: Stick to a high-fiber diet or take fiber supplements to ward off constipation. Also, ensure you are drinking enough fluids.
Pain management: Follow the prescribed pain management regime and take medications as directed.
Gentle hygiene: Use baby wipes instead of toilet paper to prevent irritation and keep the anal area clean and dry.
Monitor symptoms: Keep an eye out for any signs of complications, such as excessive bleeding or persistent incontinence. If these occur, contact your doctor immediately.

Potential Risks or Complications Associated with Sphincterotomy

While sphincterotomy is generally a safe procedure, there are certain potential complications you need to be aware of:

Short-term complications: Minor faecal incontinence or difficulty controlling gas may occur in the weeks following surgery but usually resolve as healing progresses.
Bleeding: Though rare, there is a risk of haemorrhaging during or after the operation.
Infection: As with any surgical procedure, there is a risk of getting an infection at the incision site.
Long-term Incontinence: While not common, some patients may have long-term issues with faecal incontinence. This may occur if they have pre-existing conditions that predispose them to this complication.

Overall, sphincterotomy is a well-established procedure with a high success rate and manageable risks. This makes it a preferred treatment for chronic anal fissures.

What Is the Cost of Sphincterotomy in India?

The cost of sphincterotomy in India can vary depending on multiple factors.

These cost-affecting factors include:

Surgeon’s expertise: Experienced surgeons may charge more for their services due to their high skill level and success rate.
Geographical location: The cost may vary based on where the procedure is performed. Generally, larger metropolitan areas tend to have higher costs compared to smaller towns.
Hospital or outpatient facility: Another crucial factor is whether the procedure is done in a hospital or in an outpatient facility. Hospitals usually charge more due to the additional facilities and services they offer.

Is Sphincterotomy Covered Under Insurance?

Sphincterotomy is generally covered under health insurance plans in India. This is because it’s considered a necessary surgical procedure for treating chronic anal fissures. However, do note that the extent of coverage may differ depending on your specific insurance policy and insurance provider.

Typically, most health insurance policies cover surgeon’s fees, anaesthesia charges, hospital room rent, and ICU charges (if applicable). It also includes the cost of medicines and consumables used during the procedure along with pre-operative and post-operative consultations.

Despite coverage, pre-existing anorectal conditions may have a waiting period before being covered. Also, complications arising from the procedure due to negligence or improper medical care may not be covered. Additionally, certain insurance plans may require you to co-pay a portion of the treatment’s cost. Knowing your insurance coverage before undergoing a sphincterotomy is critical. Therefore, it’s advisable to discuss with your insurance provider or your family doctor for clarification about the same.

FAQ

How long does a sphincterotomy procedure usually take?

The length of the sphincterotomy procedure can vary depending on the individual case. Typically, it takes around 20-30 minutes to be completed. The duration may be extended if there are complexities involved.

Is the sphincterotomy operation painful?

No, a sphincterotomy is carried out under anaesthesia, which means you won’t feel any pain during the operation. Pain or mild discomfort may be experienced after the anaesthesia wears off, which can be managed with prescribed painkillers.

Can I eat normally after undergoing a sphincterotomy?

Post-operation, your doctor will likely recommend a specific diet to ensure a smooth recovery. This usually includes soft foods and liquids initially and gradually reintroduction of normal food as your body adjusts.

How soon can I return to work after a sphincterotomy?

This depends on the nature of your job and how quickly your body recovers. It’s recommended to take at least one week off work after a sphincterotomy. If your job involves heavy lifting or intense physical activity, you may need to take more time off.

Will I require physical therapy after a sphincterotomy?

Physical therapy is not typically required following a sphincterotomy. However, your doctor will give you specific instructions about post-operative care, lifestyle changes and exercises. This promotes healing and prevents any further complications.

What is the success rate of sphincterotomy in India?

In India, the success rate for sphincterotomy procedures is quite high, with many patients experiencing significant relief from symptoms post-surgery. However, as with any medical intervention, results can vary among individuals due to various factors. This includes the age of the patient, overall health condition, and severity of the issue.

What follow-up care is needed after a sphincterotomy?

Post-sphincterotomy, your doctor will schedule regular follow-up appointments to monitor your healing process. It is crucial to attend these appointments and follow all the instructions given by the doctor for a speedy recovery.

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