LIS surgery scheduled

Finally having LIS surgery this week after 2 years of dealing with fissures.

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 surgery scheduled

Postby chachacha » 02 Apr 2015, 09:05

And also clarify that there is only one incision, because I (obviously) have one on the internal sphincter, but also an access cut outside.
Fissure since about 2007
Fissure diagnosed in 2011
Diltiazem for two years - didn't work well
LIS January, 2015
Hemorrhoidectomy December, 2017
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Re: LIS surgery scheduled

Postby Broncosgirl » 02 Apr 2015, 09:38

It sounds like you have a very responsive doctor. That is great! It depends on the day with mine.

I think that part of the struggle with fissures is the mental aspect. The pain can be so anxiety provoking thoughts of the pain, when it's coming next, how to avoid it, how to manage it... can consume your thoughts. I am excited for the day I go 24 hours without a single thought about my butt. I hope that day arrives soon for you too!
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Re: LIS surgery scheduled

Postby NDMK312 » 02 Apr 2015, 11:09

I've been very impressed with timeliness the office has had with responding. What's nice is because they are part of the same medical group as my family practitioner there is a portal that they use where you can email the doctors or their assistance directly through it. They say that a response will be completed in 24 hours or less, and to call the the emergency line if there is something more critical that needs to be addressed. It's wonderful!

I'm right there with you Broncosgirl. I'm considering getting some counseling on how mentally work through this better. I can't wait to get back to my yoga practice as it helped so much from a paint and mental standpoint, for now I'm using some meditation techniques to help. I try to think of things that inspire me and bring me great joy, like my family and watching my daughter grow. I want to be able to move past and not have to talk about my rear or think about bathroom habits in this way again. I'm sure my husband has heard enough for his lifetime.

Chachacha - I did ask after surgery while I was in post-op if it was only one incision and the response was yes. I was curious after seeing the video beforehand too. I can certainly ask again. However, I do feel that she would have indicated this in her reply today and said there is an incision both outside and inside.
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Re: LIS surgery scheduled

Postby msimon » 02 Apr 2015, 11:46

Wow! I am vey surprised to learn that your incision is on the INSIDE. I was about to chime in and say that for the longest time I thought my incision was on the inside because I couldn't see it but the reason for that was because I had such massive swelling, which later turned out to be an abcess. So I was going to tell you it's probably outside but you can't see it due to swelling. lol. Guess I would have been wrong ;)

Anyway, I would think an incision on the inside is not that common. I am by no means an expert but have read extensively on this surgery and never came across that. Either way, I'm sure things will heal just fine and it sounds like you are doing really well. Guess you learn something new everyday :)
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
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Re: LIS surgery scheduled

Postby NDMK312 » 02 Apr 2015, 15:52

Thanks msimon! We definitely do learn new things everyday, which is a good thing. I'm by no means and expert either, there is just too much information out there to digest. To be honest, I'm not sure what's common and what is not. I've read some posts where folks talk about having stitches too. One particular post references stitches being inside. My procedure didn't involve stitches, and the incision was left open. In doing my research, I wasn't sure if this it what they mean by open and closed methods. There must be varying techniques and I would imagine surgeons do what they were taught, are most comfortable with, and feel might be most effective based on their experience. Hopefully all helpful information that helps educate and gets folks asking good questions when they get to this path. I wonder if we pulled all the data provided be everyone in this forum if we could create our own research :o). As long as the methods all work and get us feeling better that is all that matters.

Happy to report it's later in the day and I haven't had much pain at all since early this morning. I'm lasting on just the two Ibuprofen I took then. Positive thoughts, positive thoughts, positive thoughts.
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Re: LIS surgery scheduled

Postby msimon » 02 Apr 2015, 18:34

In my understanding the difference between open and closed methods is this:

Open: incision is made externally and the internal sphincter is pulled down and out for full visualization and the muscle is cut all the way though, under direct visualization, either to the apex of the fissure or the dentate line (surgeon's preference here).

Closed: incision is also made externally and a scalpel is slipped into the intersphincteric groove (which is palpated with the finger) and slices or saws the fibers of the internal sphincter, or at least what the surgeon deems to be the internal sphincter.

The key difference between the two is that the open technique invloves full visualization of the internal sphincter, whereas the closed technique is done more by feel. The closed technique therefore carries the risk of either not cutting enough internal sphincter fibers or accidentally cutting some muscle fibers of the external sphincter (that is why my CRS does not do the closed technique).

Both are done with incisions on the outside (outside the anal verge that is) to the best of my knowledge. This is what I have learned in my research and I had it confirmed by my surgeon. My CRS does the open technique and I also had stitches. Either method can involve stitches. The stitches hurt like hell and I think a lot of my swelling was a reaction to them. I also think this is why I ended up with an infection at the incision site.

Anyway, that's just my 2 cents ;)
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
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Re: LIS surgery scheduled

Postby NDMK312 » 02 Apr 2015, 19:56

msimon, thank you for the wealth of knowledge you've provided. I wasn't doing any kind of super thorough research on the techniques, but you certainly have, which is wonderful and saves me some energy. I'm all out of that these days. Seems like you are becoming quite the expert. Again, learning something new everyday and just hoping that whatever technique my surgeon used does the trick. :)

I'm not sure I'll have much to say on here for a bit. Seems like my days are much of the same at the moment. I'm making slow but good strides I think. I'll plan on doing posts if things change drastically, otherwise not until after my post-op follow up appointment in another week. Thank you all for the support and knowledge. I'll be back hopefully in another week with a good post-op report.
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Re: LIS surgery scheduled

Postby msimon » 02 Apr 2015, 22:38

Thanks NDMK. If only with knowledge I could heal myself :( Seems like it's just time and patience and a really good surgeon. Will find out in time if I have all those ;)

I hope you continue with your steady progress and will soon have this all behind you (pun intended) :) Do keep us posted. Every success story gives the rest of us so much hope!
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
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Re: LIS surgery scheduled

Postby Broncosgirl » 13 Apr 2015, 19:11

How did your follow-up appointment go today? I hope it went well!
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Re: LIS surgery scheduled

Postby NDMK312 » 13 Apr 2015, 21:48

Hi all,

Sorry for the late update. It was a busy day today.

Post-op appointment went well. Fissures are fully healed and incision site is mostly healed. There was a very small amount of drainage still coming from it (only noticeable with a closer look). The CRS prescribed me an antibiotic that she said could speed up the healing process in addition to reducing infection. She said an abscess can form up to 4 weeks post surgery, so I should continue soaking as well. However, was not overly concerned with me and said things looked very good. I've been feeling pretty good. Better and better each day. I still have some discomfort but very little. CRS said if that persists for another week I would need to come back in for her to take another look. Overall I'm optimistic and any pain I have had is nothing compared to before. Fingers continue to remain crossed!
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