Shpincterolysis Treatment

What is shincterolysis?

In this procedure with help of instrument known as anotome, spastic muscle fibres of internal sphincter are broken at 3 o clock position with thumb pressure. Thus pain less, scar less procedure done for fissure in ano.

Why it is useful in chronic fissure?

In chronic fissure due constant trauma to fissure bad and spam internal sphincter muscles develops spasticity. Because of increased spasm, resting  tone of canal is increased. Due to this vascularity decrease in fissure bed and this further cause non healing of fissure ulcer. So by this procedure resting tone is decreased and vascularity is increased. This will further help healing of fissure ulcer.

How it is superior then other procedure?

Other procedures for chronic fissure are....

1)...Lord's dilatation

• Four finger dilation (not more than 4 cm diameter) rather than six finger
• Disadvantage of this method is then due to uncontrolled dilatation also cause stretching of external sphincter muscle → can cause partial or complete incontinence

2)...Sphincterotomy

• Surgical cutting of internal sphincter muscle either by open method  or close method
• Disadvantage
• Sometimes causes  severe bleeding during procedure
• Post op wound infection may lead to abscess