Sitting in Gatwick, waiting flight back.
This morning had appointment with dr W.
Basically he didn't tell me anything new, what I would not know. But admitted I am candidate for surgery describing my symptoms and examined me. He told there is option to do Botox, but he would not recommend as it costs more and less luckily will help comparing with LIS.
Otherwise he told I don't need to stay in London more than 3 days. 1 day before, day of surgery + 24h. Which is good...
He informed that 1% of inconsistency persists, but he told more ppl are just scared about this more than it is in fact with LIS.
Also he suggested to use 0.4 instead of 0.2 nitro, and switch over to dialetzem until I will arrange surgery as effect of nitro subsidies with time and it is good to change it, I got prescription, but price for it is 125 pounds in London Clinic!!! I refused to buy it.
The good thing is that after checking on the wound he told, that he don't need to make wound acute again, so LIS surgery is going to be breeze, just cutting the muscle. And also I will get immediate relief visiting loo.
I will post the answer on all question I collected when I will arrive home.

Hey Igrik
It must really be hard for you to choose, but Im sure you will make the right desicion. At least you are taking control now, to put an end to your missery.
I dont really beleive, that stronger nitro will help, and from my experience diltiazem is weaker in action compared to nitro. Personally, if my fissure ever gets bad again, I want botox or LIS right away!
I wish you good luck with whatever you choose? And if you want to go the diltiazem route, I might be able to help you. I pay around Ј40 for a tube, and I guess I could get some and send abroad.

I'm glad your visit went well... And I'm looking forward to reading the full lowdown when you get home.
I have got a tube of diltiazem that I only used a tiny amount of ... If you want it I don't mind sending it to you. Oh, don't worry, it's been nowhere near my bum!! Lol
OMB x

It looked ,by your report, that you did get alot of question's answered,looking to read more.
It seemed that Doctor W. was being positive and answering your question's, with the best of his knowledge.
If you are a good candidate, then it should be easy after, less painful, it all sound's very positive.
PGA....:)

Day number 53 on nitro
Painful BM in one place again. Canal spasmed again, BM is not flying out.
BM pain -3
Post BM pain - 1
Hours of spasm - 4-5h

Hello,
I am sorry it did so long for me to post. But tomorrow is my daughter birthday, so I had to sort out different things. So I as started from offtopic, I would add not funny flight I had yesterday back to home. I was not lucky to get drunk aged women sitting near me, she started to harass me, and touch on the kneel!! LOL It was only begging when we took off. I immediately asked for stewardess to change place, but plane was full. I mean completely full. The journey continued, after one hour she started to fight with me.. And I almost hit back, but tolerated. Basically I standed up and told I am not going to sit there anymore. So they offered the place in their work place to sit in front of plane. The sad shadow of this story the drunk lady was with 10 years old girl..... Girl was trying to calm down mom, but without luck. I was offered to call police when we landed, but I refused :)
Ok, offtopic is over. Back to question and answer from mr. W.
Post hemm surgery
1. Is excision site/wound big?  Moderate
2. Why do you think it didn’t heal?  He told this is a good question and nobody actually knows world fully, why it is difficult to heal wounds in this place. But common theory is about spasms
3. Do you think it is healing somehow slowly or stopped completely? Didn't get the answer recorded, and to be honest didn't get and remember what was his concern.
4. I have been using nitro since 14.06, almost 2 months, it helped to heal my fissure cause by one doctor. Probably it is worth to continue. He suggested to use 0.4, and switch over to dilitiazem. Though as I already mentioned I refused to buy it. Moreover it is analogue to nefedipine, which I started with and didn't feel anything with it, so I relate to JHH. Nitro was much more effective for me. So I doubt I have to use the one as it costs 125 pounds, and most probably is not worth this money.
LIS surgery
0. Do I have above normal anal resting pressure? Do I need some tests before surgery?He told as per symptoms yes. I asked if there is reason to make a test, and answer was no, as it would not be honest test as I am in pain, and apparently placing anything down there will cause anymore pain. Such tests are done for ones whom don't have  spasms, but just bleeding
1. Do you think LIS should resolve all my problems? He believes - yes
2. Do you need to clean up the wound to make it acute again? No, and this is actually very good, as I will not get extraordinary pain from fresh wound/fissure. I don't have scarred edges, so there is only LIS required.
3. Will you perform open or closed technique? Open, as he prefers safety to see what is being cut.
4. What would happen in the event of any complications due to surgery?? ( as I live so far away)Pity but I just noticed this one was skipped from questionnaire :(
5. For safety probably it is worth to use antibiotics right away to prevent infection?He will give a shot of antibiotics via syringe. And there is not need to use antibiotics by default
6. Inconsistency what are you comments about this? 1% and 90% of success with LIS. So he commented the more success rate, the more possible complications. Nitro 70%, Botox 80%, LIS 90%
7. How many such cases you saw, when wound is not healing after hemmie incision? If I understood him correctly, at least once per month.
8. If I will accept surgery, can we arrange it via mail so I prepare flight and stay in London Is it option to travel back to home or better to stay for several weeks in London? I have to be in London for 3 days only
So quite long post, additionally just for you interest attaching his conclusion and records he did.

This gentleman sought my advice today having found me on a fissure website in Latvia. He has been suffering for six months after a haemorrhoidectomy with a posterior fissure, he has tried all the lotions that he can find in Latvia, mostly using GTN and still is suffering considerably with pain specifically during defaecation and post defecation for a number of hours. Clinically he has got a nasty fissure with a lot of anal spasm. We have talked through the merits of sphincterotomy under these circumstances; I have been through the issue of flatus incontinence quoting around 1% with a tailored sphincterotomy. I have quoted him about an 80-90% success rate but clearly there is still a 10-20% failure rate and we have briefly discussed the possibility of advancement flaps.      
The issue of Botox I think probably is not going to work in him, he has tried very hard with the various lotions and while he makes the necessary arrangements to come over and have the surgery we have suggested he try some diltiazem ointment in the interim just in case we can get it to heal. There is no obvious need a fissurectomy as it were and simple a sphincterotomy tailored to the height of the fissure is what we plan to do.
Summary
I have got some busy days now with birthdays, so we didn't have chance to talk with my wife what to do. The surgery is expensive, but seems it should help. We just checked the wound and seems one part of it is healed. So wife is sure, that healing is in progress, but slowly. I am tired myself of this 6 month journey. So we have to sit together to think very well what to do.
PS: I also visited my local surgeon, whom did this on me. And asked to get 0.4 nitro, though pharmacy this time prepared drops instead of cream. And  I have to wait till Monday. He was very confused and demoralized, when I told I was in London and I need 3000 pounds surgery to correct his work :)

4. What would happen in the event of any complications due to surgery?? ( as I live so far away)Pity but I just noticed this one was skipped from questionnaire Sad
Hi igrik, how annoying to have a drunken woman sitting beside you,
I hope whatever you decide is best for you. Your unanswered question 4. i was in for daycase surgery for LIS, fissurectomy and tag removal but ended up staying 2 night 3 days because of low blood pressure brought on by anesthetic & pain meds so this is a complication that can happen.
Ј3000 is a lot of money (I'm lucky to be covered by health insurance) but if i wasn't I'd find the money somewhere it is so worth getting your life back. I wish you well :D 

Igrik,
This might be of interest to you??
I'd always say anything's worth a shot particularly whilst you have to make your decision as to which way to turn next......I actually switched to Diltiazem as I was not coping with the Nitro & it made a huge difference to my pain levels & I still believe, played a major role in helping my fissure heal naturally....
http://ourmeds.org/products/general_health/diltiazemcream/order/
Ј3000 is a lot of money for sure, but if LIS is your solution, then I'd say well worth every penny!!
Looking forward to reading your updates & wishing you all the best in making your decision.......

Hi ETO,
I am unable to open the link. What is the price for cream there?
Day number 53 on nitro
Painful BM in one place again. Canal spasmed, BM is not flying out.
BM pain -4
Post BM pain - 1
Hours of spasm - 4-5h
We though a lot with wife yesterday/today. And our conclusion was we should go ahead with surgery. It took long 6 months of misery for me, she was looking on this and even saw me in tears twice. There is some progress on healing of it, but very slow. And one small re-tear can return me to spasms, which again prevents healing of the subject wound itself. So naturally I would suffer at least for 6-10 months more. With good diet I would cope probably.
Well, our pros and cons were following: so many ppl had this surgery even for fissure they tore themselves, I got the one from surgery and that surgery was really painful and with more complication possibilities. I got a fissure. I never studied and was never informed about this in my first surgery. This point is also cons, as seems I am getting in low percentage of complications in surgeries. We are not so afraid of inconsistency as seems doctor knows what to do, and did many times.
So the point is that LIS is the surgery many had, and it has healed a lot of us. I do get plug effect, pain during BM, and spasms, sometime blood. One business trip can get me out of schedule and I am getting new tear on the wound. LIS was recommended as good surgery to have to me, and apparently I am very tight as per all symptoms.
Many members had LIS, and I have studied all forum back to 2008. LIS should bring relief visiting loo, it should bring conditions for wound healing.
I am only now afraid it does not work, and next step is advancement flap... but I will never know until I did it.

I'm glad you and your wife have been able to reach a decision. If you are not willing to give it time to heal naturally then LIS is the obvious choice.
You have gone about making the decision in the best possible way... Researching as much as you can, and you have one of the best colo rectal surgeons around to perform the operation on you.
I'm sure this will be the best money you have ever spent if it gives you your life back!
OMB xx