Anal fissure/ flap advancement repair failure

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Anal fissure/ flap advancement repair failure

Postby cat » 30 Oct 2015, 09:56

Hello,
I am here in desperation, hoping for a good news story!
Following an external haemorrhoidectomy earlier this year I have developed a chronic anal fissure for which I had fissurectomy and flap advancement 6 weeks ago. Have just returned from my CRS appointment to find it has been a failure and I have been rebooked for a repeat procedure next month. Has anyone here been in a similar situation with a positive outcome.
I am also interested if anyone has any tips on healing following this horrendous proceedure. Although my CRS denys I did anything wrong Im wondering If I went back to the gym too early, or shouldn't have been lifting my children.
Any input is greatly appreciated
cat
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Re: Anal fissure/ flap advancement repair failure

Postby Savaici » 30 Oct 2015, 18:51

Hi Cat, and a very big :wel: to the Forum.

One of our moderators, Suzyljank, had double flap surgery and healed very well after having many problems.

I am giving you the link here to her topics, and hope too that she will come in and give you some advice.
:smilyhug:

member/suzyljank/topics/?sf=firstpost
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Re: Anal fissure/ flap advancement repair failure

Postby msimon » 01 Nov 2015, 23:24

Hi Cat. So sorry to hear about all you have been through. I am curious, did your CRS check the resting pressure of your sphincter before doing the flap surgery?
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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Re: Anal fissure/ flap advancement repair failure

Postby cat » 02 Nov 2015, 01:24

Yes, normal pressure
cat
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Re: Anal fissure/ flap advancement repair failure

Postby msimon » 02 Nov 2015, 03:19

Where is your fissure located? Posterior (back)? Are your BMs painful/difficult? Are you on stool softeners?
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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Re: Anal fissure/ flap advancement repair failure

Postby cat » 02 Nov 2015, 04:36

I had an anterior and posterior flap repair, anterior has healed posterior (largest) has failed. I have chronic diarrhoea (pain response to endometrosis) so no stool softeners :-(
cat
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Re: Anal fissure/ flap advancement repair failure

Postby msimon » 02 Nov 2015, 11:50

Chronic diarrhea! That must be awful. What have you tried for that? I wonder if some Metamucil (bulks up the stool) or slippery elm bark capsules or peppermint oil (relaxes bowel spasms) would help...

That is good news that one of your flaps worked. The posterior is always more difficult to heal as it gets the least blood flow and is the least supported area during a BM. Hopefully a second one will do the trick.

How were your BMs after your last procedure? If you have diarrhea then maybe that is why the flap didn't stick...
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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Re: Anal fissure/ flap advancement repair failure

Postby suzyljank » 03 Nov 2015, 12:46

Hi Cat,so sorry your procedure has to be repeated. 2 years ago I have bilateral sliding flap anoplasty, 2 large flaps done. I'm not sure what your instructions were after surgery but for me I couldn't lift anything over 5 lbs for over 6 weeks. I was not to slide on my butt when getting up from a sitting position at all. I wasn't able to drive for over 2 1/2 months because of the sliding issue. I had to keep the area very clean (my husband helped me with that). Just a few weeks after surgery I had to start dilation which I still do once a day. I also take miralax once a day and always will. The donor sites of my flaps were left open, ouch. This was so new tissue would grow and help keep things more stretchable. It's very important to keep the skin stretchable. You have up to 2 years to stretch fresh scar tissue and after that you have what you have. Were your donor sites closed or open? Flap surgery is a delicate surgery and the success rate is about 70-80%. At least that's what I was told. I was told my recovery period would be 2 years. I passed that time in April. It's a slow and uncomfortable recovery and it takes time. It's very important to keep you stools soft while the flaps are new. You can tear the flap with too much explosive type diarrhea or large hard stools so keeping that delicate balance is tricky. Try not to give up. Be sure you ask your surgeon a lot of questions. I did. I think sometimes I drove him a bit crazy but he always answered everything. 6 weeks is still early in the process. I had lots of little setbacks but with everyone's help I kept going forward. I'm glad l had the procedure done. It helps tremendously but you still have to be mindful that your bottom will be different than before all this started and you have to take care of yourself. If you have any questions please feel free to ask. I'll answer whatever I can. Don't give up. Saying a prayer for you. Suzy
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Re: Anal fissure/ flap advancement repair failure

Postby cat » 03 Nov 2015, 15:10

Thankyou so much mssimon and Suzy for your response. I wasn't really given any post op instructions except take it easy for a week or 2, hence I was back at the gym after 4 weeks, I will be taking it a lot easier second time around... Nothing for 6 weeks, I am taking all the advise yourdr gave you Suzy.My stitches have pulled undone and I have fibroid scar tissue on the graft site :-(. My donor sites were closed. I believe diarrhea was also my undoing, will definitely give Metamucil a go mssimon, pain makes my diarrhea so much worse, is such a vicious cycle.
Thankyou so much for your replies, is so nice to contact someone else who can understand my situation. My poor husband can't discuss bowel motions let alone all of this!
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Re: Anal fissure/ flap advancement repair failure

Postby Savaici » 03 Nov 2015, 20:38

Suzy's posts on her surgery are so good, cat, so hope they will help you on your next surgery. "Take it easy for a week or two". Oh the understatements of surgeons... :smilyhug:
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