Sphincterotomy Info

A sphincter is a muscular structure that temporarily blocks the flow of biological substances. There are many examples of sphincters in the body. When we swallow food, there is a sphincter between the esophagus and the stomach. Bile from the gall bladder and liver is prevented from moving into the small intestine (until it is needed) by a sphincter. The sphincter that most people know about is the anal sphincter-the sphincter that allows us to control defecation. When a sphincter does not function properly, one surgical intervention to correct it is a sphincterotomy.

A sphincterotomy is a surgery to open a sphincter when flow through that sphincter is being improperly restricted. A condition in which a sphincterotomy may be performed is in the treatment of achalasia. Achalasia is a condition in which the esophagus does not move food to the stomach effectively. The lower esophageal sphincter is surgically opened to allow swallowed food to enter the stomach.

Another example would be in the treatment of gallstones or when the flow of bile is blocked. When bile cannot be released from the gallbladder into the duodenum, it can cause pain and inflammation. A sphincterotomy procedure could be performed to allow free flow of bile into the small intestine for the digestion of fats. This sphincterotomy could be done as an open surgery or endoscopically, by sending a endoscope down the esophagus to the bile duct.

In some instances, a sphincterotomy is not performed to treat a blockage, but rather a chronic condition. Anal fissures are painful lesions in the anal sphincter. The squeezing action of the sphincter combined with the passage of large diameter or hard stools can lead to anal fissures. A sphincterotomy can be performed to relax this muscle and reduce irritation and inflammation.

The traditional way to perform sphincterotomy surgery was to cut the circular muscle that makes up the sphincter. In some cases, however, it may be possible to temporarily interfere with the closure of the sphincter rather than permanently disrupting it through surgery. One alternative to sphincterotomy surgery is sphincter dilation. In this procedure, the sphincter is stretched by placing a relatively large diameter object across the sphincter. This stretching and dilation weakens the muscle.

The other means of temporary sphincterotomy is through the use of a paralytic agent. BOTOX injections are rapidly becoming a popular way to perform this procedure. This approach is called a chemical sphincterotomy. Similar to BOTOX cosmetic injections, the botulinum toxin that is injected into the sphincter relaxes the muscle. Depending on the dose used and the scope of the problem, the effect may last for days to weeks, even months.

Sphincterotomy recovery depends on which sphincter is treated. If the lower esophageal sphincter is opened, acid reflux may be an ongoing problem. Antacid medication may be prescribed as will soft, small meals until full sphincterotomy recovery is complete. Patients that have had an anal sphincterotomy must sometimes struggle with fecal incontinence. With chemical sphincterotomy, the duration of this effect is not permanent, so any complication that may arise are temporary.