Advancement flap surgery.

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Advancement flap surgery.

Postby suzyljank » 10 Sep 2012, 05:57

Years ago I had hemmies surgery that left me with stenosis. I had LIS 4 years ago and it only helped a little bit. My fissure is back and the spasms are awful at times. Thank god for miralax. My next best option is an anal flap advancement to make the anal opening larger and to remove the fissure. What I've read on this message board has scared the hell out of me. People writing about screaming in pain and crawling around on the floor in agony after the procedure. I was lucky enough to find a woman who had this done, I gave her my phone number and she called me and described step by step what happens. She kept notes after her procedure and read them to me, she also gave me the name of another woman who had the surgery with success. I've written to her and am waiting for a reply. Has anyone on this board had a positive outcome from this procedure. There aren't many option when you have stenosis and I'm terrified to begin with. Anything positive would be appreciated because I'm driving myself crazy with worry. Thanks Suzy
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Re: Advancement flap surgery.

Postby jr2 » 10 Sep 2012, 10:38

I haven't had the surgery so I can't comment on it directly, but I have had very painful surgeries with very painful recoveries, so I understand your anxiety.
I've read quite a lot of accounts across many different forums of people who have had the advancement flap surgery, and across the board it does seem to be a pretty rough recovery period as most people report it.
As far as the outcomes it seems to be pretty mixed. Some people report that even with the painful recovery it was well worth it because at the end of it things were so much better. Others have said it didn't make a bit of difference for them, and if anything it only added to their problems. Overall though from what I've observed, people seemed pretty satisfied with the outcome. One thing I did notice is that even in people who had it done and were happy with the outcome, they were pretty much sticking to a very limited diet and were resolved to taking something like Miralax for the rest of their life because there still lingered at least some discomfort, albeit less so than before the surgery.
Have you considered a second LIS? Many folks have had that done successfully as they found the first surgery to have been too conservative. Alternatively, have you considered standardized, controlled dilation for the stenosis? Not the Lord's stretch, but the standardized procedure?
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Re: Advancement flap surgery.

Postby suzyljank » 10 Sep 2012, 11:09

Hi, I am going to ask about a second LIS but I'd never do an anal stretch with an active fissure. Thanks for your reply. Suzy
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Re: Advancement flap surgery.

Postby Savaici » 10 Sep 2012, 11:53

Hello Suzy,
Sorry that you are in such pain and may you soon have resolution.
I have not had this surgery, and must confess that I only read the last person's view of this surgery this year, with the 'crawling around on the floor,' but there must surely be others who have had this and come through successfully. If the person that you spoke to has had it and come out well from it, then there are probably others who have never taken the time to come back here and given their stories of healing afterwards. There are some other links on here, as you have probably discovered yourself, for others who have had this surgery.
I would comment on the Standardized Anal Dilation to which jr2 referred. Apart from wecc, who had S.A.D. in NY with an active fissure, and is healed and gone on his way (he is an ex-marine), there is one person on here who was recently operated on at the Cleveland Clinic, where they were given Pneumatic Balloon Dilation, while having an active fissure. The main idea behind it is that the fissure can heal when there is less constant pressure on the sphincter. I have a degree of stenosis, and am doing self-dilation which has been confirmed by my doctor at Mass General, in Boston (recently voted the top hospital in the US by US News) as being a satisfactory choice for me as I do not react well to surgery having an autoimmune disease and more surgery is not recommended. Personally, before I would consider surgery on my behind, even if the surgeon suggests it (three hemorrhoid surgeries, one thrombosed hemhorrhoid surgery), I will try anything rather than someone cutting me again.
This is the link to the Cleveland Clinic post:
http://anal-fissure.org/t4737-pneumatic-balloon-dilation-and-skin-tag-removal-1-week-ago?highlight=anal+dilation
Wish you well, whatever decision you make. Know that it must be a difficult decision.
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Re: Advancement flap surgery.

Postby tiredofpain » 11 Sep 2012, 04:54

I am so sorry you are in pain, but glad you found this forum. I had Anoplasty 6 weeks ago, and like you, I read the crawling around on the floor post and was really scared. But I also read a few other positive posts and did my own research on google and the google did show that it can heal the fissure. Also this surgery seems to be a treatment option for stenosis ? You might want to research on this on google. I also got excellent support from another member on this forum who went through anoplasty and I am so gratefull for their support! Without the support the recovery would have been harder, since not many people go through with this surgery on this forum and I was not sure what to expect.
Main reason why I choose the surgery, no damange to the sphincter. So We (me and my docotor :) ) decided this was worth a try.
That being said, this surgery does involve more recovery time than LIS. I am still healing and have sore skin down there, which gets irritated by BM. My doctor said I am not completely healed and should be carefull with BMs and make sure they are soft. One really hard BM or loose BM can set me back. So recovery is really touchy with anoplasty alone.
But I never had pain that made me scream or crawl on floor! I did not have pain that was even close to the fissure pain!!! I was pleasantly surprised by my first BM.. I had general soreness and burning type of pain and sitz baths helped a lot with it. Also I did use pain medication called Toradol(which helped a lot) for one week and occasional ibuprofen after that.
I am still healing, when people who did LIS may have healed by now. The surgery does add more tissue to anal canal and may help with stenosis also. Make sure your surgeon has done a lot of these and have experience. Just like LIS, surgeon's skill is important.
My advice to you for after surgery care..
1. Keep stools soft but formed.
2. Lots of sitz bath. I took at least five.
3. If you can take two weeks from work that would be great. Three weeks even better !
4. I did not apply any cream, my surgeon did not want any creams applied there.
5. I used perianal bottle (usually given after child birth, amazon carries these) for cleaning, no wiping at all.
6. Have patience !!! This surgery needs time to heel.
Also if you can. DO NOT combine anoplasty with another hemmorhoidectomy, recovery may be painful. But this is something you have to discuss with doctor. I just gave my opinion.
Good luck to you.
TP
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Re: Advancement flap surgery.

Postby suzyljank » 11 Sep 2012, 06:23

Thank you tiredofpain. I can't tell you how much your comments mean to me. When you read only horror stories it scares the heck out of you. I'm trying not to pyshc myself out and trying to research other people outcomes was really depressing. Advancement flap surgery is really the best option for medium to severe stenosis and from what I understand it can help a great deal. Do you have stitches that go into your butt or are they only on the outside. My biggest fear is all the pain. I already use miralax to keep things moving and soft and was told I will probably be on it for the rest of my life. That I can live with though. While you were taking the pain meds how did you keep yourself from not getting constipated. I mean how did you know how much stuff to take.
Thank you again, and I hope you heal soon and get your life back. All the best Suzy.
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Re: Advancement flap surgery.

Postby tiredofpain » 11 Sep 2012, 13:48

Hi Suzy
Butt surgery is never fun and I had high levels of anxiety and fear about pain and healing. There may be four or five posts on this site about anoplasty, and some had LIS and Anoplasty, and few others did anoplasty only. It all depends on what the surgeon finds during exam. I went to four CRSs, first one said LIS right away, second one anoplasty without LIS and third one fissurectomy without LIS. I also consulted with a fourth surgeon who does standard dilation with fissurectomy, but due to location, that was not an option for me. Since two out of three local CRS suggested no LIS, I went with anoplasty with no LIS.
I had a skin tag with my fissure and also a hypertrophied papilla. So I had all the members of fissure family in my butt! From what I understood, the surgeon did fissurectomy, removed the papilla and then used the skin from the tag and folded it in. He also mentioned a lateral cut and added more skin to the canal so it can expand more. I am still not sure exactly what went on with surgery. I will ask for details during my next post op appointment.
I did not see any stitches, but when I looked two days after surgery, the skin tag was replaced with a jumbo skin tag (this thing was huge!!). I panicked and called the doctor and saw him, and he said this is ok. Some people tend to swell more after surgery (lucky me)! So two weeks pass, I still see the skin tag, but it is shrinking, and I can see one stitch sticking out and irritating the tag. The stitch was actually poking the skin tag!! Again nothing I can do about it but wait for it to fallout and eventually it did. Each week the skin tag got smaller and smaller. I still have one but it is small and according to my doctor, as long as it shrinks it is ok.. So I really did not have any stitches outside that I could see.
BM management for surgery -
one week before the surgery I started with soft foods and used miralax. Miralax gives me loose BMs, which is as bad as being constipated, so I had to be really careful. The post op instructions also said Konsyl fiber, which I took for three weeks and then stopped. Now I mostly eat vegetarian food with lots of cooked veggies, brown rice, beans, fruits, and make sure I drink lots of water. No Miralax now, relying on food to make the stools soft.
One small victory after surgery was size of my BM ! I was so happy to see that I can actually pass normal sized BMs and not be in agony!
Anyway I am still in healing stage and hoping things will work out. Feel free to ask me questions on recovery and I will be glad to answer based on what I experienced.
Take care
TP
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Re: Advancement flap surgery.

Postby tiredofpain » 11 Sep 2012, 14:55

pain medication
I was prescribed Percocet and I took this right after surgery. Boy was that a mistake! I threw up after that and was nauseated the entire night. So I ended up taking anti inflammatory drug for joint pains that night :D. Well it worked. Next morning I called the doctor and asked for torodol(anti inflammatory with no constipation side effects). This was a life saver for me. Talk with your doctor on pain management and he can prescribe you medications that are not constipating Also get your prescriptions on your pre-op visit and buy and keep it ready.
start with soft diet and miralax before surgery and stick with the same diet that works after too. That is what worked for me.
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Re: Advancement flap surgery.

Postby suzyljank » 11 Sep 2012, 17:27

Hi, tiredofpain. Your procedure sounds a little different than the one I need. My CRS wants to remove the fissure and cut a flap of skin pull it over the fissure site and suture it in my bottom. This is supposed to help heal the fissure and relieve some of the stenosis by make the opening larger and replacing scar tissue with fresh tissue that will stretch. The flap would look like a "U" and there would be stitches on the outside and in. I'm still scared to death but after 4 years you get tired of fighting with it and all the pain. Now pain management is something else I'm worried about. I too get nauseous if I take vicodin or related drug. I've heard some people take tramadol or toradol and sometimes valium to keep things relaxed. When I had the LIS surgery they gave me loritab but I didn't take it. I just used ibuprofen and I really could have used something stronger. I know I need this procedure done I just have to work myself into it and I need to stop reading everything on the internet. I get curious and then I read something awful and it makes it worse to decide. Thanks for your help. Suzy
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Re: Advancement flap surgery.

Postby chuggs13 » 12 Sep 2012, 19:55

I wanted to jump in on this. I went in for a fistulotomy of a perianal fistula on 8/31. My CRS told me he would do one of two procedures depending on how it looked once he got in there. Either lay it open, or an advancement flap surgery. He wound up doing the advancement flap because otherwise he would have had to cut through a lot of muscle. Within 2 days I was off all pain meds, and within 1.5 weeks I was back at work (I sit most of the day). I haven't gotten back to doing a lot of activity or anything else like that.
I saw him for my 1 week follow up on Monday and he said things are healing well and that there is a 70% success rate with AFS. I'm hoping for the best. I take 3 sitz baths daily and use wet wipes when I'm not at home to bathe. I know that our situations may be slightly different and I would agree with other posters that the first BM after made me sweat and cry, but its gotten better with the help of stool softeners. I am tender on my butt, and when I checked the area out down there I can see some of the stitches from the flap.
Let me know if you have specific questions.
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