LIS in UK - advice please

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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Re: LIS in UK - advice please

Postby Rachael 1984 » 01 Apr 2014, 14:37

Hello Worrier,
I am so sorry you are in the Fissure nightmare right now... I am in the UK and having similar problems. Mine started back in Sept 2012. I had some Hems banded by an awful CRS who said I had a Fissure when he banded me. The nurse said I hope he doesn't give you the cream that gives you the headaches! Then I was sent on my way.... I was ill informed and my Fissure didn't heal and I developed another 2. Moving forwards a few months later I became suicidal, took 5 months off work and had Botox in April 13. Had some relief and healing but not 100%. Next visit with CRS, I was told I had another Fissure! Cried for hours on end, after endless diet changes, Movicol, experimenting with Fibre etc. constantly being told that I can't have LIS because I am a woman so I am higher risk (shorter Sphincter muscle in women) and the fact I have IBS. Told to keep a diary and made to wait another 3 months.... Next Visit CRS said it all looks healed. I am in pain again and I doubted his examination so I insisted on a second opinion! Appointment is next week. I know I have Fissures still and always have had. Lost faith in this CRS.... He just didn't want to treat me anymore! I am praying this new man can help me. I know the LIS is easier to perform on men and you will find the right man! It's a long hard road, just so exhausting.... It has totally ruined my life and I want it back soon! Can you let me know who your CRS is? You can PM me if you don't want to say on the board.
Best of luck to you.
Hem Banding sept 2012
2Fissures
Nitro- Effective short term
April 2013-Botox-Effective short term
Diltazem-No effect, developed Rash
July 2014-Diagnosed High Resting Pressure
LIS performed on 17.9.14
Ongoing pain/re-tears. Awaiting pressure test results.
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Re: LIS in UK - advice please

Postby Worrier12345 » 02 Apr 2014, 04:42

Hi Fissurefrustration,

Are you on the waiting list for botox then? I still haven't heard anything since my last appointment with the CRS, so I'm assuming they will give me a date in May for the procedure soon.

I'm currently in a holding pattern using GTN again. It seems to work pretty well for me. I use it 2/3 times a day, I keep a fairly strict, healthy diet and I only seem to get a little blood every couple of weeks. There is little pain - mainly discomfort and some itching. However, I'm afraid to stop using the GTN, because that always results in a lot of blood.

I know I shouldn't complain, as there are so many people on here who's experience has been far,far worse than mine. I'm just tired of my life revolving around this problem. I've got a once-in-a-lifetime holiday coming up in a couple of weeks. I don't really want this to affect it, but I'm still going to have to baby my areshole the whole time, watching what I eat and drink.

The problem is: if I carry on like this and have no major relapses, what happens in May when I go for botox? Will they say it's healing do nothing and just send me home with some more cream? Will they carry out the procedure and make it worse? Should I stop using the GTN before the botox so that it retears and they have something to work with?

There just never seems to be a clear cut route to healing for good. Except for LIS from the sounds of things.
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Re: LIS in UK - advice please

Postby east_1234 » 04 Apr 2014, 17:38

I have similar experience with the NHS, although the GP was much more efficient in prescribing GTN and referring me to a CRS (I got a letter where I had to book online and choose a hospital - my closest hospital had a 60days wait so in the end I went to the Royal Berkshire hospital in Reading). I went there twice. The first time I only got to see a registrar and on her name tag it says 'general surgeon' even though she was in colorectal surgery. She torn my fissure open and made it bleed even though I had not bled for a few weeks at that point. The second time I made sure that I saw the lead CRS, Mr Philip Conaghan. My plan was to ask him for an examination under anaesthesia (EUA). At first he pretended he had no idea what "EUA" is, and then he kept saying that it will only be done under exceptional circumstances (e.g. in people with heart condition, or if he is performing Botox). And even for Botox, he will need to have examined me first (without EUA). Also, he said that he hasn't performed an LIS for years (I can't remember how long, but at least 1-2yrs). He says that nobody does LIS these days... It really doesn't tally with what I read in this forum either. It has been exactly a year now, my fissure still hasn't healed and my diet is highly restricted. I don't really have a plan, but for sure I won't be going back to the same CRS.. And I don't have thousands of pounds (or the nerves) to get an LIS privately.. Worrier, I hope that your fissures heal by themselves in time so that you won't even need LIS!!
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Re: LIS in UK - advice please

Postby Worrier12345 » 07 Apr 2014, 10:47

Thanks for your kind words east_1234, sorry to hear you've had the same disheartening experience, I hope you're on the mend. Did they offer you botox? Are you not interested trying botox?

I'm amazed by the sheer amount of conflicting information out there concerning fissure surgery and treatments, whether it's from GPs, surgeons, medical journals, medical websites, patient forums. Very little information tallies up.

From my experience, and yours, the NHS seems very reluctant to do LIS - and from the surgeons I've spoke to, they hardly do the procedure any more. It seems that it's all about botox, but that doesn't seem to tally with what I've read on here, where there is very little information on botox and even fewer success stories.

I've read a lot of articles reporting great success from botox + fissurectomy. So I assume this is the route that the NHS is going down. My surgeon didn't mention the word "fissurectomy", but did say that they usually deal with scar tissue when doing the botox procedure - so I assume that that implies that a fissurectomy is always done along with botox. If this is the route that the NHS is taking with fissures these days, and it has good results, I thought that there would be a lot more information and positive experiences on the internet regarding this procedure. But most of what I have found has been negative.

The surgeon I saw said that he sees 2 or 3 new patients a week with fissures, didn't seem to think that the botox had great success, said that LIS is still the "gold standard", but they hardly ever perform them any more. So how does that work? Either the botox is more successful than they are stating or they're performing a lot more LIS than they are stating. I don't see why they would lie about either, but the alternative is that they are doing botox on a lot of people, many of whom do not heal, and most of are just left to "live with it". Would love to find some hard statistics of exactly how many of each type of procedure is carried out by the NHS each year.

Anyway, I'm just feeling a bit jaded as I had a bad retear again today at the posterior - which the last surgeon said looked superficial, that was a month ago, so I guess this will be turning chronic as well as my anterior one. I just hope that I don't form a skin tag at the posterior, I already have one at the anterior, and it would make cleaning a nightmare if I've got one either end!

I've got the holiday of a lifetime coming up in 2 weeks. Really don't want to have to deal with this then. I'm trying to not let it bother me so that I can look forward to and enjoy my holiday. (Woe is me, eh?)

Looks like I'm stuck on the GTN for a while. Still yet to get my NHS botox appointment through for May.
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Re: LIS in UK - advice please

Postby dent1 » 08 Apr 2014, 13:13

The NICE evidence if far from convincing I have to say - this may make interesting reading! I had botox with a v y flap and then sentinel piles removed as a seperate procedure. Idon't know which bit really worked but I am healed and fine so long as I stay on movicol !!

http://cks.nice.org.uk/anal-fissure#!su ... vidence1:6
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