Interesting Article

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

Return to LIS - Considering surgery or already had it?




Interesting Article

Postby chachacha » 02 Mar 2015, 14:34

I found an article last night that I hadn't come across before in my reading, and have cited one section below. What I find most interesting, is #2. Maybe some people on this board have had a lot of spasming even after LIS because their surgeon didn't get through the entire thickness?

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2048592/

There are certain principles that should be noted:

1. The sphincterotomy should be away from the fissure site so that intact mucosal bridges fill the gap between divided muscle fibres to allow rapid healing.
2. The entire thickness of the lower internal sphincter must be divided, as any remaining intact fibres go into intense spasm to compensate for the divided fibres.
3. The mucosa over the sphincterotomy site should not be breached as this would predispose to infection.
4. The upper one-third of the sphincter must remain intact for continence.
5. The length of the sphincterotomy should be ‘tailored’ to the length of the anal fissure.
Fissure since about 2007
Fissure diagnosed in 2011
Diltiazem for two years - didn't work well
LIS January, 2015
Hemorrhoidectomy December, 2017
chachacha
Moderator
 
Posts: 1068
Topics: 19
Joined: 16 Jun 2013, 16:00
Location: Canada
Has thanked: 27 times
Been thanked: 199 times
Gender: Female

Re: Interesting Article

Postby msimon » 02 Mar 2015, 15:22

My surgery met all those principles. I got an open LIS so that ensures that all the fibers are divided, so my CRS said anyway. My bum feels really weird since surgery, like the canal is shorter. I suspect this is due to the fact that if you cut the bottom 5-6mm of the circular muscle it IS essentially shorter then. The problem I have is that I believe the upper part of the muscle still spasms. I don't think it was this much until after this last surgery (except for right after the LIS). I guess the level of injury is just too much for my sphincter to not react (even though the incision is actually outside the anus. I am very sensitized to pain down there now. But, yeah, it feels super-weird because the lower end usually feels loose and the upper end sometimes quite tight, especially during BMs, making things very difficult. Arg!

Thanks for the info though Chacha. Probably quite useful for those considering the surgery. Or who have had it and failed. I suppose the only way to know would be to have an ultrasound.
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
msimon
Moderator
 
Posts: 1343
Topics: 64
Joined: 08 Aug 2014, 19:38
Has thanked: 76 times
Been thanked: 154 times
Gender: Female

Re: Interesting Article

Postby chachacha » 02 Mar 2015, 15:58

I suppose that there is a chance then, that your sphincter will eventually get used to its new "normal" and not react the way it is doing now.

I'm not sure that many surgeons would be happy about their patients asking questions about how deep or not they cut though, so knowing the above may only be helpful if your LIS fails and you have to seek more treatment. At that point, any surgeon would probably understand why you would question the methods and details.

Keeping my fingers crossed that things improve for you soon.
Fissure since about 2007
Fissure diagnosed in 2011
Diltiazem for two years - didn't work well
LIS January, 2015
Hemorrhoidectomy December, 2017
chachacha
Moderator
 
Posts: 1068
Topics: 19
Joined: 16 Jun 2013, 16:00
Location: Canada
Has thanked: 27 times
Been thanked: 199 times
Gender: Female


  • Similar Topics
    Replies
    Views
    Last post

Return to LIS - Considering surgery or already had it?



Who is online

Users browsing this forum: No registered users and 0 guests

cron