So my surgery is scheduled for May 30th in Dallas, Texas and I have a few questions that I would desperately like some responses on prior to surgery. First, I contacted the doctors billing department to get an idea of the cost of the procedure, but they could only give me the doctor's fee because they do not do the billing for the hospital, etc. The doctors fee was $460.00 for the surgery. Does anyone know the typical cost for hospital and anesthesia, etc for this procedure?
Second and most important, I would like to know from those who have had LIS surgery, how did it affect your ability of have easier bm's. I guess what I really want to know is, how many of you had issues with tightness, spasm of the rectum that made it difficult to have a bm without straining and how did the surgery affect that. Were you able to have strain-free bm's after LIS or was it unchanged, etc. My BIGGEST concern with all of this is that I have pelvic floor dyssynergia, which means that my muscles tighten when they should relax therefore not allowing for bm's to be easy as they should. And, because my muscles are in spasm, this makes it even more difficult to have an easy bm. So, if LIS will not relieve this issue, then I feel like I would be setting myself up for failure unless I can address the issue with my bm's. My surgeon says that they are separate issues, but that the LIS would still heal my fissure regardless of the dyssynergia and spasm, but it scares me. PLEASE RESPOND with some info. on this. Thanks.

First - wishing you the best luck with your surgery and fast and complete recovery
Regrading "fees" they vary A LOT from hospital to hospital and from state to state, so I can only give you roughly what my hospital charged my insurance in CA . It was about 2,000 $$$ , as far as I remember and yes, doctor's fee was "miniscule" in comparison of what hospital charged. BUT, you see , hospital charges by an hour and charges for "room, nurses, anesthesiologist, equipment, recovery room " , etc, etc... Now, if you do not have insurance and have limited resources, than please make sure they give you detailed estimate with all fees included and listed !!!!!
Regarding LIS and effecting anal pressure - it DEFINITELY loosens "things down there" and especially immediately after the surgery and for couple of months. After surgery things start to tighten somewhat but I guess never to the "original point" of insane pressure (unless LIS was not performed correctly which happened to me and I had to have SECOND one to get full relief).
If you have additional problem that needs to be addressed than by all means talk with your CRS about that and also go and see somebody for second opinion or even third one !!!! I had to visit 5 CRS alone to find ONE that was knowledgeable enough and was able to fix the problem .
Yes, LIS makes anal pressure go down, but if your main source of fissure- forming is your pelvic floor dysfunction , that THAT should be fixed PRONTO, IMO !!!! I do not think that LIS can help if your sphincter can NOT open normally during BM and puts pressure on poop : ((( while it passes. After 2 LIS surgeries my sphincter still needs to relax fully to let a poop out or otherwise it would be too "relaxed" and cause "incontinence " -right !!!? LIS just makes "RESTING" pressure lower but sphincter still has "pressure" and strength and is very much capable to go into spasm if things are "too traumatic" and do not go easy out !!!
All in all, I would ask for second opinion I mean, LIS is not a huge deal and one might at the end "try it " anyways since one never knows "what might help" but I would definitely address pelvic floor problem full force before I tried LIS as a last resort
Hope I was of any help

mm,
fiissulyna gave some really good input and I don't have anything really more to add to what I've posted before as well as this excellent post by her above. I definitely agree about getting a detailed cost estimate if you are paying out of pocket to make sure you don't have any surprises.
Here is a link to another discussion on this topic on this board if you want to check it out.
http://anal-fissure.org/t3202-pelvic-floor-and-anal-fissure
Best of luck to you. I know this has been a long and difficult decision for you.

Hi MM,
Best wishes on your upcoming surgery and recovery
There's not much I can offer in the way of bm advice. Before and after my lis, bm's were never a problem. I didn't have a problem with straining, and never did and still don't have pain with bm's. My problem was always spasming, which would come on about 2 hours after my bm, and last for hours. This issue was resolved after surgery.
I can tell you about the charges incurred for my surgery. I'm in New Jersey...my doc charged 1,200 for the lis. The pathology cost was 336.00. The hospital charge was 6,000. Now, I do have insurance...so my out of pocket was minimal, very, in comparison to these actual charges.
Good Luck to you and please update when you can with your progress...
Angel

Thank you guys for the feedback and support. So this might be a dumb question but when props refer to spasms what does that mean? Can some describe what that is and feels LIKE?

mm92599 wrote:Thank you guys for the feedback and support. So this might be a dumb question but when props refer to spasms what does that mean? Can some describe what that is and feels LIKE?

LOL - there is no such thing as a "dumb" question when you ask about "butt problems" ; ) - butts are obviously major mystery even to CRS's to this day and age
Spasm = pain in the butt (pun intended ; )
Pain is constant, achy, and can lasts from 10 min (if one is VERY lucky ) to many hours after bowel movement and for some 24/7 (as it was case for me )
Intensity of spasm pain is pretty high :( and can be debilitating.

Hey mm,
My definition of spasm = Hell On Earth
The internal sphincter muscle goes into a spasm...a really tight contraction..sometimes for a short amount of time...sometimes for hours. This impairs the blood flow to the area, preventing healing as well as when the muscle is in such a tight spasm, it can tear/tug at the ends of the fissure, also preventing healing. That's why we get the ointments to help prevent that spasm by relaxing the muscle.
My spasms caused me horrendous pain, not just in my butt...but pain that radiated throughout my whole body . The burning was sooooo intense, like sitting on a bon-fire! There was also a feeling of sharp broken glass or knife blades stabbing me inside my butt. The pain of a spasm, for me, lasted hours on end, and no doubt rendered me helpless, crying in agony and on the verge of a breakdown. Four months of that torture, led me to my lis surgery.
Not everyone with fissures experiences spasms. Thank their lucky stars . It is a cruel symptom of fissures for some though...I'm guessing and hoping you don't get them .
Best Wishes,
Angel

Thank you guys for the responses. I have quite a bit of pain and sometimes it starts right after a bm and sometimes a few hours later. I've had pelvic floor dysfunction for many years and have suffered with chronic rectal pain prior to having my first fissure, so I'm certain that the pelvic floor problem makes the fissure pain much worse and it has made it much more difficult to distinguish between the two. I guess that is what scares me the most about going through with the surgery on the 30th. If all of this pain started with fissures, I would be much more confident, but because the fissures were more the result of the pelvic floor dysfunction, it concerns me, but I feel like I've exhausted my other options and I'm in pain every day. Also can't seem to get my bm's to cooperate. This morning was horrible as I had to strain ALOT and that has made today pretty miserable. I'll keep you all posted on what I do and whether I actually follow through with surgery.

MM - I am so sorry : ((( to hear about your suffering You know, if you truly have spasms and tried everything else than LIS could maybe help , if nothing it will make spasm pain less in intensity since it will prevent your rectum to go into "full force" clenching :( .
Perhaps you GOT a fissure because spasm made your anus so tight that poop just could not possibly go out without straining !!!! I think it can start other way around - why not !?
If you tried everything else and nothing helps than
LIS could be next step especially if your surgeon is knowledgeable abut pelvic floor problems and had success with other patients ! Did you ask him about that - if he had a patient whose pelvic pain was resolved after the LIS ?
ALSO - why not try Botox :) perhaps ? I am not proponent of Botox since it usually gives just temporarily relief BUT in your case it can perhaps be a "preview" of what might happen or not happen with pain after your anus is relaxed ??? Just a thought ...
Get well soon

I have seen two different CRS where I live, but only one of them is board certified, the other is a general surgeon who specializes in colorectal surgery. The board certified CRS has treated me numerous times over the past several years and has always recommended NOT having LIS and actually would not even do the procedure because he doesn't feel it would help me and he also feels the risk of incontinence is too great. The general surgeon said that he would do the surgery on me although he says it will not address the other issues I have with PFD, only the fissure issues. He hasn't offered the surgery because he has never identified a fissure during an exam. The CRS who I am scheduled to see for surgery is out of state and I have only communicated with him by email. Based upon the information I provided to him, he said that he would advocate for LIS to address the fissure problem, but that I would still need to address the PFD separately as the surgery would not do much for that. He seems confident that LIS would cure me of fissures forever. I would consider botox, but I have yet to find anyone who would do it. Both surgeons in town don't use it and even the out of town CRS doesn't like it.