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DIVISION  OF SPHINCTER   FOR  THERAPEUTIC   PURPOSES

1. Partial division of the sphincter from the rectal lumen.

2. Direction and permissible depth of sphincter division in the male.

3. Direction and permissible depth of sphincter division in the female.

4. Estimating the depth of sphincter incision with the scalpel blade 1 cm wide: Sphincter is dissected into the rectal lumen enlarged with rectal speculum.

5. Estimating the depth of sphincter incision with the scalpel blade 1 cm wide: Having approximated the speculum blades, the surgeon ascertains the wound depth.

In some diseases of the rectum we have

to resort to partial division of the anal sphincter in the course of operation, so that its

function could be temporarily arrested or decreased.
It is our practice to perform such sphincterotomy in operations for anorectal abscesses, anal fistulas and anal fissures by incising the sphincter

from the side of the rectal lumen and dividing the subcutaneous and, frequently, superficial portions of the external sphincter (Fig. 1). The deep portion of the sphincter is usually left intact.
Two factors are of significance for the subsequent restoration of sphincteric function: the depth of the incision made and  the duration of rectal wound packing, the latter factor being more important.
Provided the ointment packing is discontinued 3 to 5 (not morel) days postoperatively, any sphincteric wound 1—2 cm deep will heal and sphincteric function restored. In males the incision may be carried along the anterior (scrotal) or posterior (coccygeal) perineal raphes to a depth of I cm or, in rare instances, 1.5 cm (Fig. 2). In females, such an incision (1 cm deep) may be made only along the posterior rectal wall, leaving the anterior wall intact (Fig. 3).

In parous women, the posterior wall may be dissected for a distance of 0.7- 0.8 cm. hi virgins and nnlliparous women, the sphincter may be divided 1.0—1.2 cm deep. The lateral rectal walls may be incised to a depth of 0.7 cm in females and 1 cm in males. The incision depth is determined by the width of the scalpel blade which should be just 1 cm wide (Fig. 4 and 5). After the sphincter has been  incised the blades of the rectal  speculum are approximated as far as they will go, so that the wound depth can be readily ascertained from the scalpel width. The packing of the rectum and the sphinc-teric wound should be discontinued 3 days in females and 5 days in males, postoperaiively. It must be borne in mind that a more prolonged packing may lead to sphincteric weakness.