Sphincterotomy

Home » Procedures » Sphincterotomy

What Is A Sphincterotomy?

A sphincterotomy is a surgical procedure that involves making a small incision in a sphincter muscle to help alleviate pain, relieve pressure, and treat specific medical conditions. The sphincter muscles are circular muscles that control the opening and closing of various parts of the body, such as the anus and bile ducts. By cutting a small portion of the sphincter muscle, the procedure helps reduce tension and improve function, allowing for better passage of fluids and healing of tissues.

Types of Sphincterotomy

There are two primary types of sphincterotomy procedures:

1. Anal Sphincterotomy
   • This procedure is most commonly performed to treat chronic anal fissures, which are small tears or cuts in the lining of the anus. These fissures can be very painful and often fail to heal on their own due to the increased pressure of the internal anal sphincter muscle.
   • During an anal sphincterotomy, a surgeon makes a small incision in the internal anal sphincter muscle to reduce pressure, allowing the fissure to heal. This procedure is usually performed under local or general anesthesia and has a high success rate, providing long-term relief for most patients.
2. Endoscopic Sphincterotomy (Biliary Sphincterotomy)
   • An endoscopic sphincterotomy is performed to address conditions affecting the bile ducts, such as gallstones, sphincter of Oddi dysfunction, or chronic pancreatitis. These conditions can cause severe pain, jaundice, and digestive issues due to blockages in the bile ducts.
   • Using an endoscope (a flexible tube with a camera), the surgeon accesses the bile ducts through the mouth and stomach. A small incision is made in the sphincter of Oddi, the muscle that controls the flow of bile and pancreatic juice, to relieve the obstruction and improve fluid flow.
   • This minimally invasive procedure is typically performed during an ERCP (Endoscopic Retrograde Cholangiopancreatography) and does not require external incisions, reducing the risk of complications and shortening recovery time.

Conditions Treated with Sphincterotomy

Sphincterotomy is used to treat several medical conditions, including:

• Chronic Anal Fissures: Persistent tears in the anal lining that cause pain, bleeding, and discomfort during bowel movements.
• Gallstones: Stones that form in the gallbladder and can block the bile ducts, leading to severe pain and digestive problems.
• Sphincter of Oddi Dysfunction: A disorder where the sphincter muscle controlling the bile and pancreatic ducts does not function properly, causing pain and digestive issues.
• Chronic Pancreatitis: Inflammation of the pancreas that can lead to bile duct obstruction and severe abdominal pain.

Benefits of Sphincterotomy

• Minimally Invasive: Both types of sphincterotomy procedures are minimally invasive, often performed through an endoscope or with a small incision, resulting in less pain and faster recovery.
• High Success Rate: Sphincterotomy has a proven track record of success, with many patients experiencing significant relief from symptoms.
• Preserves Anatomy: Unlike more invasive surgeries, sphincterotomy does not alter the overall anatomy of the affected area, preserving future treatment options.

What to Expect During Recovery

• Anal Sphincterotomy: Most patients can go home the same day of the procedure. It is common to experience mild pain and discomfort during the first few days, which can be managed with over-the-counter pain medications. Full recovery typically takes a few weeks, and patients are advised to maintain a high-fiber diet to ease bowel movements.
• Endoscopic Sphincterotomy: Recovery is generally quick, and patients may experience mild abdominal discomfort or bloating for a few days. Most can resume normal activities within a week. Your doctor may recommend dietary changes and a follow-up visit to monitor healing.

Risks and Complications

While sphincterotomy is generally safe, there are potential risks, including:

• Infection: As with any surgical procedure, there is a small risk of infection.
• Bleeding: Some bleeding may occur at the incision site, particularly during an endoscopic sphincterotomy.
• Fecal Incontinence: In rare cases, cutting the sphincter muscle may weaken it, leading to temporary or, very rarely, persistent fecal incontinence.
• Pancreatitis: Endoscopic sphincterotomy may lead to inflammation of the pancreas, known as pancreatitis, which usually resolves with medical treatment.

By discussing your symptoms and medical history with your gastroenterologist, you can determine whether sphincterotomy is the right treatment option for you.