Sphincterectomy
Sphincterectomy is a surgical procedure involving the removal or intervention of sphincters, which are muscular structures that control the passage of substances in various parts of the body, including the anus, urinary system, and pupils of the eyes. This procedure may be indicated for a range of medical conditions, such as chronic anal fissures, severe spinal cord injuries affecting bladder control, or ocular issues like cataracts and glaucoma. In cases where a sphincter is severely damaged or non-functional, surgical excision may be necessary to restore bodily function or alleviate symptoms.
The surgery can be performed through different methods; internal sphincterectomies typically require opening the body cavity, while external procedures can be done without such incisions, using a scalpel to carefully separate the sphincter from surrounding tissues. Following the removal, patients may experience a loss of control over bodily functions, necessitating alternative management strategies. As with any surgical intervention, there are risks involved, including potential infection and complications arising from the procedure. Understanding the implications and recovery process is crucial for anyone considering or needing a sphincterectomy.
Subject Terms
Sphincterectomy
Anatomy or system affected: Anus, bladder, eyes, intestines, muscles, musculoskeletal system
Definition: The surgical removal of all or a portion of a sphincter, a ring of muscle that closes or constricts an opening or passage in the body when the muscles contract
Indications and Procedures
In the human body, sphincters can be found in the internal and external region of the anus, in the area that joins the large and small intestine, between the urinary bladder and the urethra, at the lower end of the esophagus, and in the pupil of the eye. While located in a variety of areas of the body, each has in common the ability to allow or prevent the passage of something (solid, liquid, or light) through it when relaxed or constricted, respectively. A variety of conditions may lead to the need for surgical intervention to restore the proper functioning of a sphincter or an associated organ.
Spinal cord injuries may lead to the need for bladder management intervention, especially in men. An option for those who do not prefer intermittent catheterization for bladder control is to slit the urethral sphincter to create a low-pressure bladder system that allows evacuation without the need for muscular control of the sphincter.
Splits in the lining of the rectum called anal fissures can be caused by hard bowel movements. For chronic conditions that do not heal because of anal spasms, cutting the outermost portion of the anal sphincter may relieve the spasms and speed healing.
In patients afflicted with both cataracts and glaucoma, excision of a portion of the pupillary band of the iris can aid in removing the cataract while dealing with potential pressure buildup caused by glaucoma.
Uses and Complications
Although surgery to correct tears or defects in sphincters is more common than their removal, in cases of extreme damage or disease, useless sphincters must be surgically excised. To remove internal sphincters, the patient is opened surgically, and the appropriate organs are moved to expose the sphincter in question. External sphincterectomies are performed without incisions in the body cavity. A scalpel is used to dissect the sphincter away from the surrounding tissue. Bleeding vessels are repaired, and the incisions are closed.
After removal, an individual will lack the control provided by the sphincter, such as control of defecation or urination, and alternative means of compensating for this loss will be presented to the patient. As in all surgeries, patients must be aware of any potential indications of infection, such as fever, redness at the area of incision, and bleeding.
Bibliography
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Holschneider, Alexander M., and Prem Puri, eds. Hirschsprung’s Disease and Allied Disorders. 3d ed. [N. p.]: Springer, 2010.
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Lu Y, Lin A. Lateral Internal Sphincterotomy. JAMA. 2021, vol. 325(7), pp. 702. doi:10.1001/jama.2020.16708