I have had a successful LIS surgery; however, I spent quite a bit of time talking with my CRS at my last appointment about controlled anal dilation (CAD). He is one of the top colorectal surgeons in our area and is part of a busy practice with several other CRS's. Due to some ongoing rectal pain not related to a fissure, I am doing some at home dilation to stretch and loosen the sphincter. During our conversation, he mentioned to me that they have considered offering CAD, but it is "very controversial." I asked him why. He said there are two main reasons:
1. CAD is a one size fits all approach. In other words, it doesn't matter if you are 5 feet tall or 7 feet tall, the dilation diameter is the same. With LIS, the surgeon is able to adjust the cut to each individual person/fissure, which is much more precise.
2. With CAD, there is no way to predict where the muscle fibers will tear, or how much tearing will occur. With LIS, the surgeon can control exactly how much of the muscle is cut.
I just thought I'd give another perspective from my CRS for those who are considering CAD.

Thanks for providing that additional insight from your surgeon!

From some emails from Dr. Sohn, who first brought back the idea of controlled dilation, he addressed this by saying he did vary the degree of dilation based on an individual patient, their size, age, gender, obstetrical status, etc.

Given some studies regarding both the failure rates and long-term incontinence risks of LIS (presumably attributed to poor technique by the surgeon) it seems a good thing for all of us to remember that no matter which procedure any of us choose we need to select our surgeons very carefully and be very thorough in the questions we ask.

Great posts, both of them!

Is Dilation more for reducing spasm? I no longer have spasm but sometimes dilation irritate my fissure. It's not horrible but I can feel a bit irritated. :(
I have chosen to stop doing dilation for two weeks. I want to know if my fissure can heal up even more.
I do know once the fissure is much more healed up, dilation is a must. Gotta have a strong and flexible anal canal in case of rough BM or anal sex.

please suggest where in this planet controlled anal dilatation is performed...please provide address or contact details..???

Its very urgent to save one life.