Standardized Anal Dilation research/studies

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Standardized Anal Dilation research/studies

Postby thisunpleasant2 » 28 Nov 2014, 16:14

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.
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Re: Standardized Anal Dilation research/studies

Postby asdf123456 » 28 Nov 2014, 17:47

Hi. Who was the NYC SAD CRS? I am considering giving it a shot as well and would like to talk to someone about it...
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Re: Standardized Anal Dilation research/studies

Postby Savaici » 28 Nov 2014, 21:00

Asdf -

Standardized Anal Dilation - Doctor, NYC
by Savaici » 24 Jan 2012, 10:00

http://www.colonandrectalsurgeons.com/

Also, do a search for posts by wecc, who had this done, successfully. Use the Search function above, between FAQ and Portal. He gave a very good report on his experience.
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Re: Standardized Anal Dilation research/studies

Postby Savaici » 28 Nov 2014, 21:08

One of his comments: 
standardized anal dilation
by wecc » 31 Dec 2011, 08:32

Hello All….I had many responses to my post as well as messages about this form of Anal Dilatation. First and foremost, it is not the old “lords stretch” where the CRS puts fingers in you and pulls. As I said, I would never, ever have that. That is why AD’s got such a bad rap. This standardized method is where they put for a better lack of words a very big dildo in your a** for 5-8 minutes. This in effect does the same thing as a LIS. However with that said, there is no cutting, no puss or discharge from the incision and the healing time is much less. Germany and Japan have been performing AD’s with a balloon for years with a very high rate of success. In fact, what I was told from a surgeon in Germany, at one point a few years ago some of the CRS in the major hospitals started with LIS and many went back to the balloon AD because of the post LIS issues. Interestingly enough, LIS’s are preformed more in the U.S than any other developed country. The fact is, Germany and Japan’s medical technology is about on par with us in the U.S. , yet AD are the gold standard there.

The CRS that is going to perform this AD on Wednesday , has done well over 300 LIS’s and said he would never do another one again given the success rate he has had with AD’s with truly very little complications. This CRS was named one of the top CRS’s in the New York area two years in a row and is affiliated with two large hospital, one being a major teaching hospital. 

I was going to have a LIS till I found out about this new method. Again I went for this not just because of the CRS and what he told me, I went forward with this simply because I spoke with several of this CRS patients in his waiting room. Two had an AD done on Friday morning and were back at work Monday. I spoke with one who was 6 months post and said had no complications at all. While an LIS is said to be the “gold standard” and I see posts from many who have had very good success, however I still see about 30% who have some type of complications or pain months later or longer.. 

The CRS that was going to do my LIS is a great doctor, very nice and caring. When I call up to cancel the LIS, the nurse asked why and I told her about the AD which she was not familiar with. She asked me to hold for the doctor, he asked me why I am going this route and I told him pretty much what I said above. He even went on to say the CRS that is going to perform this AD is known. What is interesting is when I asked him why he does not offer AD’s he simply said he is trained as a surgeon and is not on this technique…bingo! I am not slamming CRS’s or an LIS. All I am saying is do your research and make an informed decision.

I will keep everyone in the loop after I have this done. By the way, I found out about the new form of AD on an old post on this site. Fact is whatever way you go, this site is so darn invaluable! 

Happy New Year to all of you…god bless and talk with you on the other side.
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Re: Standardized Anal Dilation research/studies

Postby thisunpleasant2 » 28 Nov 2014, 23:48

The SAD CRS I saw was Joseph Martz at Beth Israel hospital. I would like to meet with him again and ask him for his opinion about how much trauma is likely being exerted on both the inner/external sphincter muscles with the SAD procedure, and what this means for long term damage/weakening of those muscles.
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Re: Standardized Anal Dilation research/studies

Postby sweetpea » 04 Dec 2014, 14:43

please let us know how things turn out with our SAD! very interesting thread.
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