Open vs. Closed LIS

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Open vs. Closed LIS

Postby mysorebutt » 08 Apr 2018, 16:00

So, I am scheduled for my LIS on April 20th. I have heard from many on this group as well as through my own research that there are two different techniques or types of LIS procedures...an "open" technique and a "closed" technique. I have heard that the closed technique is the better option, but I don't know that I quite understand the difference between the two. Does the open technique use an instrument to open the anal canal during the procedure whereas the closed technique does not require any opening of the anal canal? Can anyone explain the difference between the two and did the majority of patients on this group have one type over another?

My colorectal surgeon does not do very many LIS procedures in her practice and so I am very concerned about having this surgery on the 20th. I seem to recall her saying something about using forceps during the surgery and I wasn't sure if this was standard or not. Thanks.
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Re: Open vs. Closed LIS

Postby chachacha » 08 Apr 2018, 22:47

Yes, that's basically it. The open procedure is done inside the anal opening and the closed is done via an incision beside the anal opening. Mine was about 1/4 of an inch over. I'd read a lot about both procedures and couldn't really determine if one was better than the other (I read a lot of conflicting studies). I do know that I would never have requested one over the other though, because I wanted my surgeon to do what he was most comfortable with, and most experienced in. That, to me, is the most important factor.
Fissure since about 2007
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LIS January, 2015
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Re: Open vs. Closed LIS

Postby mysorebutt » 12 Apr 2018, 15:49

Thank you chachacha. In my research, I have not really found anything definitive that points at one technique being better than the other in terms of healing. I agree that I would want my surgeon to use whatever technique he/she is most comfortable with.

Do you know if LIS is typically done on one side or the other (i.e. left side or right side of the muscle)?
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Re: Open vs. Closed LIS

Postby chachacha » 12 Apr 2018, 16:57

My CRS told me that he would cut "opposite" the fissure and that apparently meant on the same side, but you have to picture a ring and then think of the fissure on one side of that ring, and the cut on the opposite side of the ring. Like a hula hoop - the cut and fissure would both be to the left (or right) if you laid it on the ground, but one would be on the top of the hula hoop and the other would be on the bottom part, that touches the ground. So, to answer your question, I guess that they would do the LIS more often on the side that most people have fissures on.
Fissure since about 2007
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Diltiazem for two years - didn't work well
LIS January, 2015
Hemorrhoidectomy December, 2017
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Re: Open vs. Closed LIS

Postby mysorebutt » 12 Apr 2018, 17:15

Ok thanks for the info. I wasn’t sure if there was a standard location for the incision with this type of surgery. My surgery is set for next Friday and I’m having severe anxiety about it. The anslxiety has really caused issues with BM’s over the past few weeks (going several times a day and having loose BM’s) and that has caused more pain than usual. My surgeon doesn’t do LIS much at all so I am concerned she may not have the experience to know all the ins and outs of the procedure.
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Re: Open vs. Closed LIS

Postby Hopefull123 » 12 Apr 2018, 17:22

If she is a certified surgeon don't worry, she should know as these are basics. If it will make you feel better ask her before the procedures what exactly she will do, where will cut, etc. Definitely ask for post operative care instructions and what to expect in respect to pain, bleeding, discharge, etc. My fissure was anterior, but the incision was on the right side, so it all varies. It healed very quickly. I think my doc technique was closed because in my record he mentions scalpel size 11. But do ask her which side she will cut so you will know that the localized pain later is in fact from the incision so you don't worry that it is something else. The incision pain was the only pain left after two,three weeks of pain all over because of the surgery, large instruments in your anus during the procedure, numbing shots, etc. But after that this localized pain from the incision lasts about 5 to 6 weeks, but it is very minor.
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Re: Open vs. Closed LIS

Postby mysorebutt » 12 Apr 2018, 17:39

Thanks. She is a board certified CRS who has been in practice for about 15 years, so I’m sure she must know what she’s doing. I just worry because of her lack of experience with LIS and because she has never really examined me for a fissure to know what is going on up there. I have severe pelvic floor dysfunction and have been dealing with chronic pain for almost 20 years so she is afraid to examine me as she doesn’t want to stir up my chronic pain symptoms. My chronic pain is mostly severe pain with sitting or with standing for long periods. Basically anything that puts pressure or stress on the pelvic floor causes pain. The fissures are secondary and started several years after my pelvic pain began. So even if the fissure issue resolves, I will still have substantial pain in the rectum.
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Re: Open vs. Closed LIS

Postby Hopefull123 » 12 Apr 2018, 17:41

Try to stay positive, part of the muscle will be cut, so a big deal of the pressure will be released, hopefully this will resolve all other issues.
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