Pre LIS & Skin Tag Removal Appointment Q & A

Are you having, or have you had a Lateral Internal Sphincterotomy (LIS)? Please share your experiences here, or ask any questions.

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Pre LIS & Skin Tag Removal Appointment Q & A

Postby sphinctersaurus » 24 Feb 2011, 04:36

Hi everyone!
Before I visited my CRS for the big pre-surgery talk, I put together a big list of questions. The consultation was recorded so I thought I’d put a transcript of it here as I guess we would all be wondering many of the same things prior to surgery. Some of my questions are lifted straight from Happyass’ list (Thanks Happy!). It’s not exactly verbatim; as I’m a very lazy person, and much of my neurotic rambling has been removed ... just to make me look a little less like a total LOON!
Sphinct: How exactly will the op be performed?
CRS: The operation can be performed one of two ways – A closed incision or and open incision. For a closed incision, I will feel with my finger for the fibres of the internal sphincter muscle (for the difference between the internal and external fibres, as the two muscles are very close together) If I can feel those fibres very clearly, I’ll use a very small blade and I will feel with my finger how much of the muscle is being divided ... and that’s it. The other way is if you can’t feel the gap between the internal and external fibres very easily and we might be concerned about cutting to much muscle, then we actually cut the skin and open it up and keep the internal sphincter away from the external and then cut it under direct vision. Those are the two different ways, I do both.
Sphinct: So the first way (closed), you wouldn’t actually cut through the ...
CRS: You’d have a tiny skin incision which you probably wouldn’t even notice. The second way (open) you’d have a slightly larger skin incision, which I’d probably need to put a couple of little sutures in.
Sphinct: Would the sutures be dissolvable?
CRS: No. They’d disappear within about ten days. They are actually on the outside, but they will come loose and fall out.
Sphinct: Will the LIS site have stitches?
CRS: Possibly. It depends how easy it is to feel that muscle, because sometimes it’s very easy and sometimes it’s not. We want to make sure it’s a safe operation.

Sphinct: And the first method (the closed incision) ... Do you cauterize the wound?
CRS: No. About 80 to 90 % of them (operations) are done like that. I make the incision and then I just put a bit of pressure on it (incision) for about a minute afterwards and that stops the bleeding. Then I will put a little bit of gauze in ... not into the anus, but at the opening. That puts a little bit of pressure on the wound to stop it bleeding. If we are going to take the skin tag off, you will end up with an open wound where the skin tag is. We’ll put a little bit of local aesthetic on that so that it’s comfortable when you wake up.
Sphinct: And that won’t be stitched?
CRS: No. You can’t stitch it ... It will heal on its own. You will have a little round open wound which will gradually close and heal.
Sphinct: And that can’t be cauterized?
CRS: No.
Sphinct: What chance is there of infection?
CRS: Pretty low actually.
Sphinct: When I go home ... How do you recommend I avoid infection? Do I need to take regular soaks in the bath?
CRS: No ... For most people, it’s not an issue. We’ll give you one dose of antibiotics during the surgery ... just one dose. Just keep your bowels regular and keep the wound clean. You can use a shower head attachment to wash if it hurts to wipe, or you can use wipes, but they might be a bit stingy. You could also get one of those hose attachments you can buy for the taps in your bath tub, and wash it that way.
Sphinct: What degree of pain and bruising should I expect?
CRS: Not a lot. You might get a bit of bruising. The pain of the fissure is usually gone. The pain of the incision isn’t as bad as the pain of the fissure. It’s more likely that where the skin tag is removed, that will be more uncomfortable because you’ll have a little open wound there for a while.
Sphinct: What medications will I be sent home with?
CRS: You won’t be sent home with antibiotics, but you will be sent home with painkillers. We’ll give you three different painkillers, but generally I think that’s overkill. We’ll give you Panadol (paracetamol), an anti-inflammatory and also with a few Tramadol just in case you need them. Generally, I’d say you probably won’t need that (Tramadol).
Sphinct: Will the antibiotics given during the operation cause constipation?
CRS: No.

Sphinct: Are either of my wounds likely to produce a discharge? How long?
CRS: You may get some discharge from the open wound where the skin tag was. It may be yellow with a little blood in it. That is just tissue fluid. That might go on for a few days. It is not a sign of infection.
Sphinct: What signs of infection do I need to look out for?
CRS: Increase in pain and increase in body temperature, but it’s very unlikely.
Sphinct: At what point post op can I consider myself clear of the risk of infection:
CRS: With a closed approach it’s not really a huge risk. The only potential for infection is where the skin tag is taken off, but it really is very unlikely. The body’s very good at fighting off infection in this area.
Sphinct: What about the risk of developing an abscess or fistula?
CRS: Abscesses and Fistulas are a separate disease process. They don’t occur because of surgery. They occur on their own.
Sphinct: What, in your experience, is an average recovery time?
CRS: Most people wake up and are immediately much better off after the surgery than before, and are pretty well back at work straight away. Others take a day or two.
Sphinct: Given what you’ve just said about most people feeling better straight away ... My concern was that because I don’t get the horrible spasms that some people do, and I’m not in terrible pain all the time, that I might feel worse post surgery rather than better.
CRS: What you’re talking about is the extreme. For those people, surgery isn’t a choice. You just have to do it. They are probably about 5% of the people I see. It’s not a huge amount.
So that’s it – My pre op appointment! Hopefully this will be of help to anyone considering surgery. It should also provide some laughs (the recovery time question) to veterans of LIS.
:D
Sorry about the layout. Hope it isn't too hard to read. Image
sphinctersaurus
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Re: Pre LIS & Skin Tag Removal Appointment Q & A

Postby cherylk » 24 Feb 2011, 06:32

Good info, Sphinct. Your CRS sounds great in that he was so patient to answer your many questions!! Keep us posted. I forgot when your surgery date is going to be.
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Re: Pre LIS & Skin Tag Removal Appointment Q & A

Postby alpinestrawberry » 24 Feb 2011, 08:25

Wow sphinct! You were way more prepared than I was to ask these questions. I guess I didn't expect to go in there and have the surgeon agree to surgery so readily...I was more prepared to have to beg for it than I was to ask technical questions!
I wish I'd remembered to ask if I'll be having open or closed LIS...I'm assuming closed because he said I'll just have a tiny puncture wound where he goes in to make the incision.
I'm not quite buying that an abscess is a separate disease process...sure seems like you could get an infection from this one way or another...haven't there been some members here who have gotten an abscess after surgery?
My surgeon was really over-optimistic about recovery times too...'do it on a Friday be a new person by Monday!' he says...yeah right! Clearly that hasn't been your experience Sphinct, and I don't expect it to be mine either.
Great info!
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Re: Pre LIS & Skin Tag Removal Appointment Q & A

Postby sphinctersaurus » 24 Feb 2011, 17:53

Sorry ... I forgot to mention that I had LIS and Skin Tag removal (closed incision) on the 10th of Feb.
Most of the information and advice from the CRS turned out to be accurate, but some of it ... Not so much.
The recovery time advice in particular, is a bit of a joke. There's no way I could have gotten back to work "straight away" and not in "a day or two" either. I went back to work after about 10 days. I probably could have done so a couple of days sooner though.
Alpine - Yeah, I know what you mean - I was a little skeptical about the whole Abscess being a seperate disease process too. I guess I should have asked her to explain what she meant.
I really get the impression that surgeons don't have a lot to do with post surgery care. I think mine would have been happy to leave it to my primary doctor. I wouldn't let him near my bottom if he were the last physician on earth! He has smallish hands ... Well ... kind of big palms with small fingers. But, even so ...
I've become very protective of my precious rear end.
Only properly qualified (AND small) hands are getting near it!
:D
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Re: Pre LIS & Skin Tag Removal Appointment Q & A

Postby cherylk » 24 Feb 2011, 18:17

Sphinct,
A man from our area was in NZ during the recent quake on his way back from Antartica. Here is the link for his account of the event:
http://www.pjstar.com/homepage/x889929745/Roger-John-describes-New-Zealand-quake-experience
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Re: Pre LIS & Skin Tag Removal Appointment Q & A

Postby Guest » 24 Feb 2011, 21:24

Good information Sphinct. This will be very helpful to others.
Alpine,
I asked a lot of questions but open or closed LIS wasn't one of them, Lol
I didn't have any stitches with the LIS or Tag removal to my knowledge. My husband was the observer of that area for a month or more. I was scared to death to look! :roll:
The recovery times are a joke, though. I think my recovery went pretty well but it didn't happen in three days!
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Re: Pre LIS & Skin Tag Removal Appointment Q & A

Postby sphinctersaurus » 24 Feb 2011, 22:27

Cheryl - Fascinating story! I've heard some pretty amazing ones in the last few days, and some that are hard to listen to ... So sad.
What's interesting, is listening to people trying to describe the violence of the event. In many cases, words just fail people. I've never experienced a major quake, just fairly small ones. Hope I never do, but in this part of the world, it certainly is a possibility.
Dawn - No ... Even the reigning queen of LIS recovery wasn't back to normal in three days! Image That's just silly ... Of course, I didn't believe her. I've read too many surgery stories on here to buy that!
I actually did ask about the risk of incontinence too, but for some reason I didn't catch it on my recording. From memory, she said that any time a muscle is cut, there is a risk of weakening it, but they are careful not to cut too much and so it doesn't happen. I also asked her if she'd personally ever had anyone become incontinent. She gave a little laugh and told me she had not. Like she would have told me anyway! I'm sure for a Colorectal Surgeon, rendering a patient incontinent is pretty much the worst thing you could do, besides killing them. I'm sure they work very hard to make sure neither of these things ever happens!
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Re: Pre LIS & Skin Tag Removal Appointment Q & A

Postby happyass » 24 Feb 2011, 23:16

sphinctersaurus,
i have been thinking about you lately.
i am sorry i haven't shown much support to you lately in your posts altho you are on my mind.
i hope you are feeling better and that in time, you will get better and better.
i am glad that none of your family was injured during what has been going on over there in NZ, so i ask God to keep you all safe.
big hugs 2 u,
happy
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Re: Pre LIS & Skin Tag Removal Appointment Q & A

Postby Bumbutt » 25 Feb 2011, 02:21

Awesome report Sphinct! That was a good idea to record it, and pass on the information to all of us. That was funny... one day of recovery! Now there's a CRS with confidence!!
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Re: Pre LIS & Skin Tag Removal Appointment Q & A

Postby sphinctersaurus » 25 Feb 2011, 04:26

Happy - You're plenty supportive. Makes me feel really good to know that you care. Image
I'm doing Ok. The last couple of days have been better, and I see from your other post that you're doing better too. It scared me to read that you had been so low emotionally during your first week of recovery. My stomach sank with worry when I read you post. So, I'm really happy that things are getting better for you. May it be so for us all! Thanks so much for your support Happy... It really means a lot.
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