Fissurectomy and Lords Procedure

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Fissurectomy and Lords Procedure

Postby lytefall » 30 Mar 2017, 21:33

Does anyone have experience with these whose had a good outcome?

I have a previously healed AF (2009) with a large skin tag that caused me long standing difficulty passing stool and gas but surgeons recommended no surgery until it started causing me pain. Skip forward to 2015 and now a new AF for the last 2 years. The tag seems like its inflammed lately as well.

I've done all the conventional non invasive treatments and my surgeon says its time to cut. In the beginning he was talking about doing LIS, but is now saying fissurectomy and a modified Lords Procedure is my best bet. Reading about them online is giving me nothing but anxiety.

I go back to see surgeon again in 2 weeks to discuss further, but when I asked why not LIS last visit he just said that in his experience patients in my situation and presentation do better with fissurectomy and Lords as the LIS is too high risk for incontinence.

This seems to contradict everything I read online. Frustrating....
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Re: Fissurectomy and Lords Procedure

Postby patience_and_healing » 01 Apr 2017, 07:15

It sounds like a tough choice. Out of curiosity, where are you located? All literature I've read till now says that the Lord's procedure is outdated and LIS is the 'gold standard'. This is because the former is uncontrolled and carries a risk of shock, infection and incontinence. LIS has a risk of incontinence too, but less so. I would suggest finding a surgeon who is more up to date with current standards. I've read about patients getting Botox with fissure removal, which would definitely be safer than Lord's
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: Fissurectomy and Lords Procedure

Postby lytefall » 01 Apr 2017, 07:34

I am in Canada. Near one of the larger cities in Ontario. This surgeon is a well respected and experienced surgeon.

My thing is that he didn't outright choose to do this. He initially said LIS was the treatment of choice but then changed his mind. Which makes me feel like this is a conscious choice based on his experience and my case.

I too have read that LIS is the gold standard. The surgeon appears to know this and chose not to do it.
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Re: Fissurectomy and Lords Procedure

Postby patience_and_healing » 01 Apr 2017, 07:40

Perhaps ask him how forceful of a dilation he will be doing? And does he do it gradually so that muscle fibers are not torn? There is a naturopath in Portland, Oregon who does this procedure, called Dr. Cranford. You can read up on his technique, he talks about how it's important to do the dilation slowly. I considered going to him but then I found a case where he had his license suspended for drug abuse and canned the idea.
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: Fissurectomy and Lords Procedure

Postby lytefall » 04 Apr 2017, 22:02

Thanks! I am going back to see him in a couple weeks. Got plenty of questions.
lytefall
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Re: Fissurectomy and Lords Procedure

Postby patience_and_healing » 22 Apr 2017, 00:54

Hey lytefall, how did it go at the CRS? Did you get your concerns addressed?
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: Fissurectomy and Lords Procedure

Postby lytefall » 22 Apr 2017, 07:05

Yes I did. He is doing fissurectomy because he has to remove a large sentinel tag anyway. He said he doesn't think a sphincterotomy is necessary. He is doing modified Lords procedure (regular Lords is 4 fingers from 2 hands for 4min). He said he's just doing single hand 3 fingers 4 min. He said he's never had anyone develop incontinece with this method.

So my mind is at ease a little for now. He's a very well respected surgeon with a lot of experience so I think I just need to trust him and not let my anxiety get the better of me.

Thanks for asking!
lytefall
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Re: Fissurectomy and Lords Procedure

Postby patience_and_healing » 23 Apr 2017, 20:40

Is your surgeon an older one? The ones who've graduated long ago still believe in using manual dilation as a treatment. I would encourage you to get a second opinion on this procedure though. Controlled dilation is probably a better option since no two manual dilations can have the same results.
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
patience_and_healing
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Posts: 983
Topics: 38
Joined: 24 Feb 2017, 15:46
Location: California
Has thanked: 58 times
Been thanked: 117 times
Gender: Female


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