5 min follow up procedure

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5 min follow up procedure

Postby Sal7864 » 09 Jul 2017, 19:36

I had anal fissure with partial LIS surgery on 2/10/17. 5 months later it still has not completlely healed so Dr. is talking
about a second 5 min. procedure where he would scoop out granules and clean the wound under anesthesia so it would have a chance to heal. Anyone ever hear of this or ever had it done? He says i could do it on a Friday and go back to work on a Monday. I am very leery of doing this because i had an abcess form after my surgery, I was out of work 6 weeks and lost 30 lbs, i cant afford to lose and more weight or be out of work (IF i do decide to do this , I will take a week vacation)

I am also wondering if coconut oil would help heal it. Ive read where it supposed to heave healing properties. I am also having leakage /seepage issues after BMs which he says will stop when the wound Is completely healed. I HOPE that is true. I could live with the slow healing if i didnt have the damn seepage.

Any thoughts appreciated.
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Re: 5 min follow up procedure

Postby patience_and_healing » 10 Jul 2017, 00:01

There are several members on this forum who've posted about having the wound cleaned with silver nitrate to speed up healing. You can search the forum to find the relevant posts but that might just cause anxiety too. I think coconut oil is unlikely to fix something that's deep under the surface and would do nothing for granulated tissue.

Has your surgeon experienced this problem with any other patient? Did you have any stitches after the LIS was done?
8/16-12/16: Fissure due to antibiotics
5/17: Botox to sphincter, fissure healed
9/19: Trigger point injections and pudendal nerve block
11/19: Botox to pelvic floor
8/20: Botox to pelvic floor in new location.
Currently in pelvic physical therapy
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Re: 5 min follow up procedure

Postby Sal7864 » 10 Jul 2017, 05:22

Thank you, I will check with my surgeon in advised I don't think he used stitches but I will find out. I think I would rather have him try silver nitrate again rather than the regular surgery
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Re: 5 min follow up procedure

Postby Payne4me » 13 Jul 2017, 19:44

Sal7864 Im troubled by your statement..."a partial LIS"...let me preface this by saying Im not a Dr...but the only way this procedure has positive results is with the cut being complete..According to my CRS,,,incontinence has not happened in over 4,000 patients (worries of this...would be the only reason not to make a complete surgical cut) Im not out of the woods as i had surgery last Thursday...but if you havent had successful results from the procedure...it might be time for a new CRS....it is my understanding that a LIS is performed to increase the blood flow to the fissure...to improve the chances for healing.....like to hear your progress...
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Re: 5 min follow up procedure

Postby Sal7864 » 13 Jul 2017, 19:55

Thanks for the reply I am meeting with my surgeon again on the 31st to discuss options I am really leaning against doing any further surgery if it's healing up eating slowly I may have to just let it
Take its course I think they call it partial because he didn't feel the need to have to open up all the way I don't know I'm not really sure but if what your crs saying is true then I am troubled by it as well I will ask him and keep you in the loop and good luck with your healing hopefully everything goes well. The funny thing is I do not have any pain when I go at all
It's just there's some leakage afterwards which I would take any day over the that being said I want this thing to finish healing so my leakage stops he thinks it once it does finish healing the leakage will stop. And if he says this procedure was the only way then I might get a second opinion I can't go down for the count and another six weeks or lose more weight.
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Re: 5 min follow up procedure

Postby Payne4me » 14 Jul 2017, 14:36

A writing from another message board I visit for sports content...and while you should take all posts on the internet with a grain of salt...this guys post is spot on...especially the last couple paragraphs....the guy is super intelligent.

.I had the LIS four years ago. It has nothing to do with diet. It's about your nervous system. The AS is actually two doughnut-shaped muscles, not one. One is controlled "voluntarily" by your conscious thoughts. The other is autonomic. You have zero control of it. It is not all that rare for the involuntary muscle ring of the AS to go into spasm and simply lock tight. This is why the root cause is neurological, not diet.† The clamping alone does not cause the sharp pain. The clamping causes a dull ache. What causes the sharp/stinging pain is an unfortunate formation of the anatomy whereby a couple of arteries actually run through the inside of the AS rather than around the AS. These arteries get choked when the AS goes into spasm. That cuts off blood to the area "down there" and you develop fissures. It's the fissure that is the source of the pain and when the nitroglycerine treatment proves useless, the LIS procedure is "indicated". What the LIS procedure does (if conducted carefully by a delicate surgeon) is that it literally slices through the involuntary half of the AS, rendering that one doughnut muscle incapable of constricting. You are saved from becoming incontinent because the "voluntary" half of the AS still functions per your brainy commands. The fissure (once blood is restored) heals all by itself in 2-4 weeks. I have never had another fissure since then.

As for the post-op constipation. That's a common side-effect of the opiods used during the operation as well as the percocet (an opiod) you take afterwards.

I had my LIS done in White Plains Hospital on an outpatient basis. I was up and about before noon and got home around 1 PM and went to sleep. That night I felt I was having a baby. OMG, my dark side was getting ripped open from inside. I thought fersure a baby Alien was gonna burst from between my ass cheeks. I had to self-administer two enemæ to get the log to pass and to gain relief. I swore off the percocet. Actually, i immediately reduced from four-a-day to one-a-day and simply endured the operation site pain. I also stopped the percocet altogether after the fourth day when the Rx was to last a full week.

Thing of it is.... I've been suffering fissures maybe once-twice a year since college Shaddap, ADG. I've gotten all manner of useless advice:

You need more dietary fiber...
Change your diet to eliminate this and that...
You're not cleaning up "down there" enough...
Use this nitroglycerine cream...
Use this anaesthetic cream...
Get a "standing desk"

The fissures always healed in a matter of 2-3 weeks without me doing anything. So I just lived with it.

But in 2013, I had one which would not heal. It lasted months and I began losing a lot of weight. I went to three doctors. The first one was my GI guy who performs my five-year endoscopies. He gave me some balm and pads and ordered me to consume fiber supplements. That was worthless. I went to someone else. Was given nitroglycerine mixed with Vaseline. That wasted another month. I finally found a surgeon via the internet who specializes in this and he told me something different than I had heard from every other doctor over forty years.
This is not your fault. It's your nervous system causing the AS to spasm and clamp. We'll do an LIS procedure. You're actually on the table for about ten minutes. The rest is prep and post-op.
He then illustrated what happens.
I'm on my back, my ankles are raised and slung from a trapeze like some S&M posture. I'm "cleaned" down there and the surgeon palpates to locate the boundary of my AS. He then takes a scalpel and pushes it directly in just to the outside of the AS. He then turns it 90° to cut through the involuntary half of the AS and that's it. He surrenders the scalpel and simply presses down hard for five minutes to get the bleeding to stop. Then he throws in a couple of stitches of absorbable suture and I'm done. Actually, he threw in a hemorrhoid removal for free whilst he was already "there"
I was off the table within 20 minutes of entering the O/R. I slept off the drugs in the recovery room and was awake (albeit groggy) circa 11:30 AM. I was discharged within the hour.

There was one follow-up about five days later in his office. There was a second follow-up the next week. There was a closeout follow-up one month after the operation.

I have not suffered since.

In the days leading up to the operation, I lost 20 pounds over four weeks. That's because I could not sit down for more than a few minutes. So I powerWalked every day, rain or shine and that did bring psychological relief. i was still plenty "sore" down there. But the walking would help take my mind off it.
Now I recall reading on the internet that some patients need the procedure repeated after a few years because the AS heals the severed loop. I mentioned this to my surgeon and asked what his experience has been.

He said he's performed hundreds of LIS and not a single patient of his has ever needed a second one.

If you need a second one, it's because the first one was not done properly and a bit of the involuntary muscle was not severed, therefore the muscle was able to heal over the course of 4-8 years. The technique i use ensures the entire loop is cut. It cannot heal because the two ends are incapable of touching each other. They have to be touching for them to heal.
By technique, he meant the LIS. I.e., there are three different ways to perform a sphincterotomy. The LIS is the one with the best success rate. ironically, it's also the quickest. But it requires a deft hand and good feel for the knife to know when it has done its job fully without cutting more than it should. When the LIS is done properly, there is no regrowth. The fix is permanent
† One method of treating this is Botox. Botox is injected at the nerve site, getting the muscle to relax. But the problem with the Botox approach is that the nerve eventually stops responding to the Botox. Each dose lasts fewer and fewer days. It stops working after a couple of years. So the LIS becomes necessary anyway.
A special thanks to the Rodent..who took the time to write this for me!!!!
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Re: 5 min follow up procedure

Postby patience_and_healing » 14 Jul 2017, 18:28

That's a really interesting account that you found online, Payne4me. Thanks for posting it here.

Partial LIS means that the surgeon only cuts muscle equal to the length of the fissure, not more or less. This technique has been found to reduce chances of incontinence and leakage after the operation. A complete LIS is usually not recommended due to the higher chances of post op complications.
8/16-12/16: Fissure due to antibiotics
5/17: Botox to sphincter, fissure healed
9/19: Trigger point injections and pudendal nerve block
11/19: Botox to pelvic floor
8/20: Botox to pelvic floor in new location.
Currently in pelvic physical therapy
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Re: 5 min follow up procedure

Postby Payne4me » 14 Jul 2017, 21:04

P&H: I was not sure that the reason for partial LIS surgery was prevention of possible incontinence...i guessed it if you read back a couple of posts...My Dr said not to worry...and the Rodent commented similarly. But Im willing to bet that the majority of "sufferers" that come here would take a little spotting in thier underwear with the confidence that the pains would never reoccur...I definitely belong to that group of "sufferers"
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Re: 5 min follow up procedure

Postby Payne4me » 15 Jul 2017, 04:48

P&H: Ive done a little more investigation into the technique the surgeon employees...I could find nothing to collaborate a cut equal in length to the fissure can you give me a source...here is the best source i have found:
The surgery can be performed using 2 techniques:

The open technique involves making an incision across the intersphincteric groove, separating the internal sphincter from the anal mucosa by blunt dissection, and dividing the internal sphincter using scissors.
The closed technique or subcutaneous technique involves making a small incision at the intersphincteric groove, inserting a scalpel with the blade parallel to the internal sphincter and advancing it along the intersphincteric groove, and then rotating the scalpel towards the internal sphincter and dividing it.
The fissures usually heal within 3 weeks. By undergoing this procedure, patients experience long-lasting results and reduced recurrence as compared to treatment with medicine. Recurrence rate after LIS is found in about 5% of all cases.
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Re: 5 min follow up procedure

Postby Canadabum » 15 Jul 2017, 07:23

Great post and great explanation of the procedure. Thank you for sharing.
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