Internal anal sphincterotomy

Anal internal sphincterotomy for the surgical treatment of anal fissure. The internal sphincter has the characteristics of the involuntary ring muscle of the digestive tract, which is prone to spasm and contraction. This is the main cause of pain in the anal fissure. Therefore, an anal internal sphincterotomy can be used to treat the anal fissure. General anal internal sphincterotomy rarely causes fecal incontinence. Methods There were three kinds of posterior anal internal sphincterotomy, lateral anal internal sphincterotomy and lateral subcutaneous anal sphincter incision, each with its own advantages and disadvantages. Treatment of diseases: anal fissure Indication Anal internal sphincterotomy is suitable for simple anal fissure, postprandial pain, accompanied by anal sphincter spasm. Surgical procedure Posterior anal internal sphincterotomy (1) Use the double-leaf open anal mirror to show the anal fissure in the middle of the posterior, directly cut the lower edge of the internal sphincter through the anal fissure, from the anal margin to the tooth line, about 1.5cm long, and the internal and external sphincter tissue should also be separated. (2) If there is a sentinel or anal papilla hypertrophy, it should be removed together. (3) When there is bleeding, you can use electrocautery to stop bleeding, or use cotton balls to sputum 1:1000 adrenaline solution and then stop bleeding. Lateral anal internal sphincterotomy (1) After touching the sphincter groove with the indicator finger, a 2 cm curved incision was made on the outer side of the anal margin. (2) Using the curved vascular clamp to extend from the incision to the sphincter sulcus, after exposing the internal sphincter, clamp the lower edge of the internal sphincter with two small curved vascular clamps and separate upwards to the tooth line. (3) Cut a part of the internal sphincter with scissors to give a biopsy under direct vision to confirm whether it is an internal sphincter. (4) The two ends are ligated to stop bleeding, and the skin is sutured with a fine non-absorbent line. The advantage of this method is that the operation is performed under direct vision, the muscles are completely cut off, the bleeding is completely stopped, and the tissue can be taken for biopsy to confirm whether the cut tissue is the internal sphincter. Lateral subcutaneous anal internal sphincterotomy (1) Goligher method: After touching the sphincter sulcus, use an ophthalmologic cataract knife to puncture the inner and outer sphincters, and cut the internal sphincter from the outside to avoid penetrating the anal canal. (2) Nataras method: The scalpel is inserted under the mucosa, and the internal sphincter is cut from the inside to the outside. Avoid penetrating the rectal mucosa. The advantage of the lateral subcutaneous anal internal sphincterotomy is that it avoids open wounds, relieves pain, and heals quickly. Disadvantages: cutting off the muscles is sometimes not complete enough, sometimes easy to bleed, and it is not easy to stop bleeding. All the above 3 methods can remove the external hemorrhoids and hypertrophy nipples at the same time. complication 1. Wound bleeding is more common in the lateral subcutaneous sphincter cut, especially in the first surgery. The main points to avoid bleeding are: 1 familiar with the internal and external sphincter anatomy, do not wear the rectal mucosa when the knife is inserted; 2 press the bleeding for several minutes after the operation until the wound has no bleeding; 3 pay attention to aseptic operation during operation . 2. Wound infection is mainly caused by hematoma in the wound, so hemostasis should be thorough.