Have any of you had LIS to prevent a fissure?

Are you having, or have you had a Lateral Internal Sphincterotomy (LIS)? Please share your experiences here, or ask any questions.

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Have any of you had LIS to prevent a fissure?

Postby NickF » 02 Dec 2017, 01:05

I'm due to have my LIS in 3 weeks. When I met with my CRS, she said that she couldn't see a fissure this time (she saw a fissure last time we met) I've been told this a lot over the years by different CRS's. When I'm torn, they see it, when I heal, they dont. Recurrent acute fissureing. Anyway, she told me that she has never done an LIS on someone without an active fissure.

Has anyone here had a LIS for recurrent fissures but not one, long chronic fissure?

Also, I have IBD of some sort. My last colonoscopy showed inflammation in the rectum and colon. Prometheus IBD blood test came back positive for Crohns Disease. I question this diagnosis even though my docs seem convinced. If anyone with an IBD has had this operation done and has anything to chime in, that would be lovely too.

Thank you :)
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Re: Have any of you had LIS to prevent a fissure?

Postby Mypoorbutt » 02 Dec 2017, 09:41

Hi, I have crohns and my healing from my LIS was very painful but my fissure was active and was down to the muscle. Also my crohns still flares and it was these that made the healing process long and painful.
I was sometimes going 8 times in 2 hours which became intolerable and I had to go back on steroids.
But my fissure did heal about the 6 month mark and now I only get pain when I’m having a flare, all my other BM’s are pain free
I’m sure the LIS will be easy to recover from if your fissure is healed and should prevent and more re tears, I have re torn since the LIS but I healed in about a week.
Good luck
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Re: Have any of you had LIS to prevent a fissure?

Postby patience_and_healing » 03 Dec 2017, 12:32

Sorry I don't have anything useful to add but I hope the operation will help you be free of recurrent fissures in the future. I'm just wondering though, does your muscle stay in spasm even when the acute fissure has healed? Because if not, wouldn't the LIS cause incontinence? It would be great if you could clarify this for me because this is something I've wondered about in regards to myself.
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Re: Have any of you had LIS to prevent a fissure?

Postby NickF » 03 Dec 2017, 13:04

Hi patience and healing. Thanks you for your reply. In response to your message, no the muscle doesn’t stay in spasm when the fissure heals. My doctors have observed through tests and scope exams that when my fissure tears, my sphincter pressure increases greatly. And when I heal, it returns to normal (confirmed by anorectal manometry. And yes, there absolutely is a good chance I will become incontinent from LIS. When I had Botox done, it gave me temporary incontinence for 2 weeks. But at the end of the day, I’ll accept permanent incontinence if it will take away my pain. When my fissure tears, I’m in agony for up to 8 hours per day. And I can’t live like that. So in your case, it’s up to you what risks you are willing to take. I’ve spent 2 years with constantly recurring fissures and it’s ruined my life. I’ve exhausted all other options besides surgery - gtn cream for 8 weeks, diltiazem for 16 weeks in total and Botox. My surgeon has never done an LIS on someone like me to prevent future fissures. I’ve spoken with 6 CRS surgeons and they all agree that they don’t know what will happen and they wouldn’t do the operation if they had any other choice. I know what it’s like to have fecal incontinence and it’s really s**t but I can live with that over constant fissures. The bigger worry is that the operation doesn’t work and I still get the fissures.
I’ll let you know what happens after the operation. Obviously I have some form of underlying inflammatory bowel disease and I am not you, so don’t take my results, whatever they are, too literally for your situation.
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Re: Have any of you had LIS to prevent a fissure?

Postby Mypoorbutt » 03 Dec 2017, 14:04

I can understand it took me 4 goes to find a surgeon willing to do LIS on me due to my explosive liquid BMs they all said when I flared I would suffer incontinence.
I told them I would prefer that to the unending agony of a fissure that refused to heal and spasms for 12/24 hours after a BM... still they refused
I was lucky enough to find a CRS who specialised in IBD’s and he did my LIS he did not cut the length of the fissure and I have suffered no incontinence at all.
During Botox the sphincter cannot spasm it cannot tense I had no spasms after Botox at all. After LIS it still can tense and unfortunately for me mine could still go into major spasms, so hopefully you won’t get much if any incontinence
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Re: Have any of you had LIS to prevent a fissure?

Postby patience_and_healing » 03 Dec 2017, 14:14

Like MPB says, I hope you will not see any incontinence issues at all. Have you tried pelvic floor physical therapy in the past? Sometimes the cause lies in tight pelvic floor muscles as it does for me, and a good PT could really help you.
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Re: Have any of you had LIS to prevent a fissure?

Postby NickF » 03 Dec 2017, 16:19

MPB, I have heard lots of people say that the Botox stops the sphincter spams. However, for myself and several people I spoke to, this wasnt the case. This was also backed up by a few studies I posted on here a while ago. For some people, Botox seems to increase the pressure. This was certainly what I experienced. Before I had Botox, I would have spasms for 4-6 hours. After Botox, my spasms always lasted at least 8 and were more intense.

I'm so glad that the LIS worked for you though :) Although your recover sounds rough. It seems like other than the underlying Crohns, you were a good candidate in that you clearly had a high sphincter pressure and a chronic fissure right down to the muscle.

PAH, I haven't tried pelvic floor physical therapy but it sounds interesting. If my surgery fails, I'll look into it. Thank you for the advice!
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Re: Have any of you had LIS to prevent a fissure?

Postby Katie » 05 Dec 2017, 07:41

Nick F I'm seeing my surgeon today I have been on the cream over 2 years had two ops and 5 bottox and nothing has worked so I'm going down the lis route very scaryed and my surgeon does not want me to have it but after 12 years I need to live with out pain! My mind races over and over what if this that if that but one thing is for sure I can't go on living this way! I'm hoping my op will be after christmas
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Re: Have any of you had LIS to prevent a fissure?

Postby NickF » 05 Dec 2017, 11:43

Well best of luck to you Katie. It sounds like you are in a similar position to some of us that decided that this was the only option left.
I don’t know if this will help ease your mind, but’s it’s way I see it. When you have no other choice but to try something in an attempt to be free of extreme pain, as long as that attempt won’t kill you, it has to be worth a try. I don’t know what your background is so I can’t comment on why your surgeon was so reluctant to do a LIS. But all the surgeons I met were reluctant for these reasons:

1) it could make me incontinent due to underlying inflammatory bowel disease. I’d rather be incontinent than in pain

2) the level of inflammation in my rectum could mean that I have an unhealed wound with infections, abscesses etc. I’d rather they try and they can deal with that later than stay in pain.

3) a high level of inflammation in my rectum could result in uncontrollable bleeding like this surgeon experienced with a different anal operation on a patient with crohns. I’m in a hospital, no better place to have uncontrollable bleeding.

4) it won’t work. Well it won’t heal if they don’t try either.

And 5) it could all be a disaster. It doesn’t work, I get infections, a fistula as well as a fissure and everything is the worst it could be. So I have an ostomy of sorts. Again, I’d rather have that than a life of pain

I guess what I’m trying to say here is that there will always be a level of risk. For some of us, it will be significantly higher than others. But you reach a stage where that pain is too great to bear anymore and you accept the risks and potential consequences. No one other than you can decide where that tipping point is. But it’s usually years when you are someone who is at high risk for this operation.

I wish you the best of luck Katie. And if you do decide to go through with it, remember that in the vast majority of cases, even for people with underlying conditions (and I don’t know if you have one), this is a very successful operation in the hands of a good surgeon.

Please let me know you get on!
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Re: Have any of you had LIS to prevent a fissure?

Postby Hopefull123 » 05 Dec 2017, 12:14

Hi Katie, if your CRS doesn't want to approve the surgery without an active fissure, just wait until next retore and go immediately for approval.
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