Long time reader.

I'm male, 38, was diagnosed with the typical posterior midline fissure about 4 years ago. Have had hemorrhoids since high school, and possibly undiagnosed fissures as well (that were mistaken for hems). Hemorrhoids have been banded a few times, and are not bothersome anymore.

Since diagnosis, I've successfully learned how to heal fissures, with a variety of methods:

- dietary changes
- bowel habits
- lifestyle changes
- nitroglycerine cream
- self dilation

I'll try to write more details about the above in later posts, especially the self dilation, which I'm quite positive about.

The main reason I'm on the verge of choosing LIS is recurrence problems. Over four years, I've healed and retorn multiple times, often with 6+ months inbetween major problems. All the methods above are great, and will help heal even chronic fissures. However, they're very time intensive, not flawless, and not really permanent solutions if the problem is a high internal sphincter resting pressure.

It's been a couple of years since I've had severe pain, but I still get some, and am still anxious at every bowel movement. Sometimes the recurrences just happen for no good reason - my stools are soft now, which was the primary cause of my AFs previously. I'm not sure if my worst pain was ever as bad as some of the descriptions on here (I feel for some of you), but pain is very mental - I wonder if I've just adapted to it.

I don't know what the long term, detailed results of LIS will be for me, but feel like I'm reaching it. I just saw my CRS yesterday, and we're all sync'd up. I just need to call in an appointment for the surgery. She does it in-office under local anaesthesia.

Here's my list of pros and cons for LIS:

Pros
- main goal is to reduce or eliminate long term recurrences
- 24/7 reduction of resting pressure, not just 3-4 hours after each dilation or NTG cream.
- hopefully no more creams, lubes, etc. hopefully my butt can serve it's primary purpose most of the time.
- less daily time devoted to issues
- regain mental and social aspects of life
- possibly regain certain physical aspects (exercise, walking, swimming, etc.)
- possibly be able to travel again

Cons
- pain of procedure, recovery time
- possible incontinence
- possible infection, abscess
- possible fistula. This scares me the most.

For those who have had LIS surgery (or considering it), could you share a pros/cons list? Anything I'm missing that you considered?

Thanks!

Your pros are spot on and are the real reasons why you should consider. When I look at your cons I had the same fears. My recovery time has been quick. At day 7 today and pretty much back to all of my normal activities except workouts. I'm sitting ou til Monday. I noticed huge decrease in pain even the 1st day after. My doc only did LIS. Nothing else. I am not incontinent (huge relief). Currently at day 7 after surgery so still hoping for no infection. So far so good. Fistula scares me too but not really sure what they are. I also think there is less of a risk depending on whether the doc does closed LIS or open LIS. I think I may have read that. I am so happy I did it. I couldn't live like that anymore. It was awful and all consuming; so I am so thankful this gave me my life back.

Thanks for the post. I'm a 48 year old male and my history is very very similar. Tear, months of pain and earnest effort to heal, finally get over it for long periods, then have it return - process of obsessive compulsive care taking starts all over again.

I am really close to choosing the LIS route. One less invasive option is Botox, but my research does not give me great confidence in that.

How I long for the old times when I just went to the toilet and it was done

It becomes all consuming. I'm Day 8 out of surgery now and it's incredible to be able to go to the bathroom and not hurt forever after. I just can't even really convey how important this was to me and how thrilled I am. If you've been doing this for a long time, I doubt botox will work. My surgeon was cool about having it on hand. I told her to do right by me and either do the botox or the LIS based on what she saw when she got in there. In this practice, they put you to sleep for either procedure so we could do that. She said I had a large fissure and therefore chose the LIS in order to fully solve my problem and I'm so thankful she did. I am still taking a few sitz baths but I will stop those soon and I hope my morning routine will just be me waking, using the bathroom and moving on with my day in a comfortable manner. So far it's been amazing. It sounds like you're a candidate. good luck.

I got a LIS 7 month ago, and I am still in constant pain (8-10). My AF healed up after the LIS, but the pain after is severe. I had a MR and they can't find the reason for the pain.
The doc said it perhaps is a nerve damage.

sorry SL, don't give up, seek some natural methods if its a nerve issue I wish you the best

tangotango

Did you go through LIS ?

I am 50, had AF first in November 2014 and Nitro has helped a lot (headaches are really not bad and
don't bother me) but I can't completely heal for some reason, despite a high fiber diet. Dilt cream has never helped.
I still have bouts of bleeding, burning, some pain (though rarely more than 1-3). I keep thinking that I can go
on like this for ever.

Your brother in pain

My surgeon has suggested either Botox or another LIS to solve my high pressures. On ultrasound there is no evidence of sphincter division so although a second LIS risks are as with first. HELP! I have to make a decision. I have sought help from this new CRS who I trust and he seems to have the measure of me too, which is obviously a nervous patient. I have been in daily pain since first op last September, sitting and walking makes it worse. Very scared but know I need some sort of op to help me. Anyone had two LIS ops?