Hey, ya I went to the doc at Center for Colorectal Health in Beverly Hills. It was years ago, I can't recall the exact name of the doc but it was something strange (to me anyhow) and that sounds about right. Definitely H-something.
Anyhow to be honest, I had a problem with the fissure healing but not staying healed too. After this length of time, I'd think something more aggressive than just nitro might be in order. Why not give Botox a shot earlier and see if it helps? If you've been using nitro for a while and keep retearing, it sounds like it probably won't help in the long run.
I can't say much about whether a fissurectomy is warranted, as I didn't have one myself -- sorry... I think in most cases LIS is the primary procedure and fissurectomy is secondary. That is, LIS is the one that actually gets at the root of the problem, and fissurectomy is to help LIS do its job. AFAIK whether a fissurectomy is warranted is usually determined by how the fissure looks, i.e., whether it the edges look like they're scarred real badly or not.
Honestly I think I'd be more interested in curing the fistula than the fissure at this point. IIRC fistulas almost never resolve on their own, and you definitely don't want that to get worse. If memory serves, it's actually tougher to fix than a fissure. There are some some anecdotal reports that antibiotics like metronizadole can help "cure" or at least prevent the worsening of small fistulas, but generally speaking, the only way to treat them is through surgery. I kind of wonder why the docs are advising against surgery for either the fistula or the fissure, but if they gave specific reasons, then they may know better.

Regarding the doc, yeah I went to the clinic, but this was years ago. I left Los Angeles in the early 2000's. The guy was indeed an older fellow. It was H-something, Persian or middle eastern I believe. I went there for hemorrhoids, though, so I never got into much discussion with him about anything else. Weird that he would be a CRS and not do fissure surgeries, but sometimes that happens when folks don't feel their hands are very stable anymore (just speculating).

Well my GS gave no indications I need the fistula surgery right away since I've already had this for months now and told me no rush and to think it over on when I want to schedule for the surgery and the CRS says to try and heal the fissure first.My GS is a knumbskull and offers no advice whatsoever on the fissure and the CRS wants to go back to step one on healing the fissure.I don't know if I'm making the fistula worse somehow internally by holding off on the surgery but it actually feels better than it did months ago.Right now I suppose as long as the fistula doesn't bother me I'm going to give my fissure one last shot til January and healed or not I'm going through with the fistula surgery and hope the procedure makes the fissure worse so my GS will have to deal with it.But anyhow yeah the last time you've been to Dr.H was 2000,I think he definately aged a lot since then.Probably right on the hands not being stable anymore.

I thought I would chime in with my experience.
They found a fistula during my LIS surgery last Jan. I had a the fistula "layed open" to allow healing from inside out.
I just had surgery about 3 weeks ago for an abscess. And sure enough I had another Fistula connected to the abscess. This time it involved a lot of my muscle so I have a draining seton installed now. And not real sure my next step since I am now being referred to a GI to investigate if I have IBD impacting my anal area.
How do you think the abscess is draining? Through the fistula? Or is it coming out from the surface. I would be concerned if the abscess is being drained through the fistula. If the fistula closed off because of healing then the abscess couldn't drain making pure misery. Plus the fact you have an active infection that could be potentially harming tissue long term. I would be pretty nervous leaving an active infection going unchecked until Jan.

LOL ok I know it's not meant to funny but your description of your GS is pretty hilarious afugh Maybe you could check with a GI doc or another CRS or something? If your GS isn't doing much for the fissure and the dude in Beverly Hills' surgical days are behind him, you'd still need someone else to even try Botox anyway right? Seems like it'd be ideal to see someone who knows about fissures, Botox, plus fistulas, since everything is related.
I'm kinda with Paul on the fistula thing. It depends where it is, but in general, a fistula supposedly doesn't cause as much pain as a fissure, and is therefore easier to ignore. But I read a good deal about them when I had my abscess drainage surgery, and AFAIK they don't really heal on their own. Seems like it'd be safer to least try to have a knowledgeable CRS keep an eye on it to minimize the chances of it getting worse (i.e., deeper/wider fistulous track). I know it's all unsolicited input but after the ass-related ups and downs you've been through the last year, just play it safe is all I'm saying :)

To answer your question Paul it's draining from the abcess on the surface.Ya I've been mulling over what you guys have said today and I decided I'm going ahead with the surgery sooner.Lol Maybe knumbskull is too strong of a description but I trust him to do my surgery since he has operated on my mother before and he seems knowledgable very sure of himself about doing the procedure when he was explaining it to me.Plus the clinic is only a 4 minute drive from my house.The fissure pain wise is at a zero and it will heal and return again sooner or later so I might as well take care of one problem and I'll focus on the other after.I have been thinking of going to another CRS in Burbank but time is of the essence to me if I'm going through with the surgery and I don't have the time for extra appointments.Figure I'll schedule it tomorrow and hopefully they can fit me in within this month.I have a family reunion to attend on Jan.8th in Norcal and hopefully I will be good enough to travel by then.Thank you for scaring me into getting the surgery sooner you guys But seriously thanks for the help and info,I appreciate it.

BTW Paul how is the bm after the fistula surgery?Is it painful?Good luck with your GI appt.hopefully it's good news and nothing more than a fistula.

My last fistula surgery hasn't been to bad in terms of BM. The drain is annoying as hell though. It kind of looks like a zip tie that enters the incision where the abscess was and comes out of my anus creating a loop. It goes through the fistula tunnel to keep everything draining.
My surgery in Jan was another story. I had intense pain/spasms for months after a BM. But I had an LIS, fistula layed open, two fissurotomy's, and a skin tag removed. So the whole area was raw. Unfortunately, the LIS didn't instantly relieve the spasms, which for me, is the worst part of a fissure IMO. It is hard for me to know how much the fistula added to the misery.
Also, have you asked the GS about how much muscle may be cut opening the tunnel up? I hear "the goal is to preserve muscle" all the time from my CRS - which gives me comfort. Has he fully evaluated the path of the fistula? Does he do this type of surgery often? I guess for me I believe in using an expert, in this case a CRS, for treating these rear end issues. There is a lot at stake if they are not skilled enough and damage the sphincter muscle.
I wish you the best of luck. Getting the abscess treated now is a good idea. I had my abscess for about 3 weeks before I finally got it drained and I have never felt so awful.

Well I just made the call to schedule it.Donna the assistant told me the earliest they can do it is Nov.1st but she still has to check with the surgery center if they have a room available for that day so she will give me a call back.I have to get a physical with my GP a week before which I'm not happy about.My GS hasn't fully evaluated me yet but he told me the same thing about preserving the muscle to prevent incontinence and he emphasised that to me the last time I saw him.Sheez Paul that surgery you had January makes the last one a cakewalk.With all that you've been through this year your like my hero for the moment.