Hello all,
I was hoping to open a new discussion of this topic.
I have read the comments by the handful of members here who have had this procedure, and I have some more questions about it, and was hoping this thread could be a place to post links or comments with new insights into this procedure. Links to published studies or medical journal articles would be particularly great. Or comments from anyone whose CRS seemed to have clear-headed thoughts on SAD (as opposed to - "that's that crazy old technique that has 80% incontinence rates").
I have seen 2 CRSs, one who thinks dilation is a bad idea, and one who thinks LIS is a bad idea...so the question is, who to believe, and more importantly, what are the facts (if it is even possible to figure that out)?
SAD (standardized anal dilation) is only performed by a handful of people here in the US, and as a result, it seems like there are no large-scale studies of this newer, standardized procedure (40mm stretch for 6 minutes). Maybe there are studies from other countries? The surgeon I saw in NYC who has been performing SAD for 15 years said he has never had a patient end up with incontinence from the procedure, and that SAD is superior to LIS because there is no incision and no risk of infection. But these are just his personal results (and one has to assume that if a patient had a problem after this procedure, he or she would probably go see a different doctor, and this surgeon would never know that the SAD procedure caused the incontinence). The surgeon who does SAD also said the statistics for incontinence after LIS are just too high for him to be comfortable with. He cites much higher incontinence rates than the CRS I saw who does LIS...
The other CRS I saw (many times, for 2 rounds of Botox, some cauterization, Nifedipene, etc), also does not like cutting muscle, but thinks that is the best option, and he performs LIS. He has done this for 15 years or so. He also says none of his patients have ended up with incontinence, but I'm just as skeptical about this claim as I am about the other surgeon's claim of 0% incontinence. I read a comment on this board that this same LIS surgeon thinks surgeons who do dilation are crazy.
Who to believe?
I found one medical article online which had a comment by a doctor who was critical of SAD. This doctor said that SAD, unlike LIS, can damage both the inner sphincter muscle AND the external sphincter muscle (LIS presumably only affects the inner muscle). So this is a bad thing. The same doctor also said that unless patients who have had SAD undergo a CT scan type test (? I think it was like a CT scan, I need to find that article again) after the procedure, there is no way of knowing how much trauma was actually done to the sphincter muscles. I took this to mean that with LIS, the doctor knows exactly how much of the inner sphincter muscle is being cut, but with SAD, it is hard to tell how much the muscles are being damaged. And as a result, in ten or twenty years, this may lead to higher rates of incontinence with people who had SAD. (This is just my interpretation of this article, not sure if I am entirely correct in my interpretation...). So this makes me uncomfortable about the SAD technique.
That said, after having spoken with the CRS who conducts the SAD technique, I am leaning (slightly) towards SAD....
I just wish there were more studies about it...
So....and thanks for reading all this....I thought maybe we could put our heads together and try to track down as many clinical studies and comments from CRSs as we possibly can...I will post links in another comment as I find them...
Although it is very interesting to hear about other people's personal experiences with either of these procedures (and I am extremely grateful for all the folks who have shared their experiences here), I'm trying to track down more research into the science behind these two techniques....if that makes any sense....Some people have suggested that in the US, surgeons have embraced LIS because they get paid more for that technique...I'm not much of a conspiracy theorist, but I have to say that that theory doesn't seem far-fetched. Unfortunately it's a sad truth that $ seems to factor too much into decisions made by the medical industry in this country...
In any case, any and all comments welcome...
Thanks in advance.