Lloyd, I cannot believe you have had LIS 3 times! How awful! And botox each time? That doesn't make sense to me, isn't that overkill? I was asking about whether you have had a pressure test/manometry because some fissures are not caused by/perpetuated by high resting pressure. I these cases, botox and LIS are unlikely to help.
In your picture it looks like you have an anterior/front fissure....am i right?
Do you have incontinence?