What Is a Sphincterotomy?

Internal anal sphincterotomy is used for surgical treatment of anal fissure. The internal sphincter has the characteristics of involuntary circular muscles of the digestive tract and is prone to spasms and contractions. This is the main cause of pain in the anal fissure. Therefore, the internal anal sphincterotomy can be used to treat the anal fissure. General partial anal sphincterotomy rarely causes fecal incontinence. There are three methods of posterior internal anal sphincterotomy, lateral anal sphincterotomy and lateral subcutaneous anal sphincterotomy, each with its advantages and disadvantages.

Anal sphincterotomy

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Internal anal sphincterotomy is used for surgical treatment of anal fissure. The internal sphincter has the characteristics of involuntary circular muscles of the digestive tract and is prone to spasms and contractions. This is the main cause of pain in the anal fissure. Therefore, the internal anal sphincterotomy can be used to treat the anal fissure. General partial anal sphincterotomy rarely causes fecal incontinence. There are three methods of posterior internal anal sphincterotomy, lateral anal sphincterotomy and lateral subcutaneous anal sphincterotomy, each with its advantages and disadvantages.

Chinese name

Anal sphincterotomy

Foreign name

Internal sphincterotomy of the anus

Anal sphincterotomy

Internal sphincterotomy; posterior internal anal sphincterotomy; lateral anal sphincterotomy; lateral subcutaneous anal sphincterotomy

General Surgery / Anal Canal Surgery / Anal Surgery / Anal Fissure Surgery

49.5901

Internal anal sphincterotomy is used for surgical treatment of anal fissure. The internal sphincter has the characteristics of involuntary circular muscles of the digestive tract and is prone to spasms and contractions. This is the main cause of pain in the anal fissure. Therefore, the internal anal sphincterotomy can be used to treat the anal fissure. General partial anal sphincterotomy rarely causes fecal incontinence. There are three methods of posterior internal anal sphincterotomy, lateral anal sphincterotomy and lateral subcutaneous anal sphincterotomy, each with its advantages and disadvantages.

Internal anal sphincterotomy is suitable for simple anal fissure, severe pain after stool, and anal sphincter spasm.

1. Posterior anal sphincterotomy

(1) Double-leaf open anus is used to show the median anal fissure after the anal fissure. The lower edge of the internal sphincter is cut directly through the anal fissure, and the length from the anal edge to the dental line is about 1.5 cm.

(2) If there are sentinel hemorrhoids or anal papilla hypertrophy, they should be removed together.

(3) When there is bleeding, use electrocautery to stop bleeding, or use cotton ball to dip 1: 1000 adrenaline solution to compress the bleeding.

2. Lateral anal sphincterotomy

(1) After touching the sphincter groove with the index finger, make a 2cm arc incision on the skin outside the anal margin.

(2) Extend the incision to the sphincteric groove with the mid-curve vascular forceps. After exposing the inner sphincter, use two small-curve vascular forceps to clamp the lower edge of the inner sphincter and separate the tooth line upward.

(3) Cut out part of the internal sphincter with scissors under direct vision and send it for biopsy to confirm whether it is the internal sphincter.

(4) Both ends are ligated to stop bleeding, and the skin is sutured with a fine non-absorbent thread.

The advantage of this method is that the surgery is performed under direct vision, the muscle is completely cut, the hemostasis is complete, and the tissue can be taken for biopsy to confirm whether the cut tissue is the internal sphincter.

3. Lateral subcutaneous anal sphincterotomy

(1) Goligher method: After touching the sphincter groove, use an ophthalmic cataract to penetrate between the internal and external sphincter, and cut the internal sphincter from outside to inside to avoid penetrating the skin of the anal canal.

(2) Nataras method: pierce the scalpel under the mucous membrane and cut off the internal sphincter from the inside out. Avoid penetrating the rectal mucosa.

The advantages of lateral subcutaneous anal sphincterotomy are that it avoids open wounds, reduces pain, and heals quickly. Disadvantages: Sometimes the muscle is not completely cut, sometimes bleeding is easy, and hemostasis is not easy.

The above 3 methods can remove external hemorrhoids and hypertrophic nipples at the same time.

1. The sphincteric groove should be positioned accurately, otherwise it is easy to be wrong.

2. Hemostasis should be thorough.

3. Anal fissure accompanied by external hemorrhoids, anal papillary hypertrophy and anal fistula, it is best to deal with it at the same time.

4. Lateral subcutaneous anal sphincterotomy is only suitable for experienced anorectal surgeons.

1. Wound bleeding is more common in lateral subcutaneous sphincterotomy, especially for the first time. The main points to avoid bleeding are: familiar with the anatomy of the internal and external sphincter, do not penetrate the rectal mucosa when the knife penetrates; compress the hemostasis for several minutes after the operation until the wound has no bleeding; .

2. Wound infection is mainly caused by wound hematoma, so hemostasis should be thorough.