LIS or SAD need some advice have questions

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LIS or SAD need some advice have questions

Postby flamingo » 23 May 2012, 16:25

Hello -- so I have come to the point that I know that this is not going to heal on its own, and I have to do something... I am in the NYC area, and WECC's Dr. recommended a CRS in NYC who performs SAD. I went to him, and he was pretty straightforward -- he could do it, and it should be fine. Not a lot to talk about, or maybe I did not have the right questions at the time.
Still a lot of logistics for me to get to NYC for a procedure, and I am somewhat uncertain since it so much less often done, and despite WECC's great recovery, since my fissure is somewhat older - chronic - appearing and disappearing over the last few years, until now when it has decided to stay.
So I went to a local surgeon, who wants to do the LIS along with "cleaning up the edges" so that there would be fresh skin there to heal. I did ask about healing time, etc. and she thought about a week, which is so different from what I read here. When I told her that, she said that was probably because some people have other procedures done at the same time as well. Thoughts on this??
Anyway, sorry to be so long, but one question that comes to mind is -- if you do the SAD for a chronic fissure -- does it heal without the "cleaning up the edges" being done?
I guess I am weighing that as obviously the non-surgical option, but one that is a bit more "out there" in my mind, and what is considered to be the "gold Standard."
I would very much appreciate any comments, thoughts, suggestions, etc.....
Thank you!
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Re: LIS or SAD need some advice have questions

Postby jr2 » 23 May 2012, 18:15

flamingo,
I would think that if when you saw the SAD doctor that if he thought the wound edges needed cleaning up he would have recommended that since it can be done when the SAD is performed.
Fissurectomy, or cleaning up the edges, is yet another area of controversy among colorectal surgeons, as if there wasn't enough confusion already for us to sort through in making decisions. Some of them feel it is necessary, others feel it is totally unnecessary and can even be counterproductive in healing. So, it really depends on the surgeon you talk to and what your own intuition tells you.
In my mind, dilation makes a lot of sense. By removing the need for an incision, you remove the risks associated with an incision, including bleeding, infection, risk of fistula formation, and scarring. Since we are not talking about the old ways of dilation that were uncontrolled, and the controlled dilation has been around for a good 20 years or so and has proven itself safe and efficacious, it would be my first choice if I lived close enough to a surgeon who performs it.
That's just my opinion. There is nothing wrong with opting for LIS and fissurectomy if that is what makes you feel more comfortable. I think it comes down to checking in with our own intuition and deciding what makes us feel most comfortable, and which doctor we feel most comfortable trusting with our care.
Good luck with your decision!
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Re: LIS or SAD need some advice have questions

Postby happyass » 23 May 2012, 18:26

hi flamingo,
will your insurance cover both or are you out of pocket for either procedure?
if you are covered by insurance, there probably isn't much to risk then trying the less invasive procedure first. i am not familiar with SAD so i don't know what is involved with it.
i had a fissure for over 7 years and into year 8, it was the worst. i had a good break between like years 6 and 8 and then it just came back with all its might. so yes, i had a very chronic fissure.
i had LIS, my CRS did not do a fissurectomy as she does not believe in that but she did 'clean up" the tissue surrounding the fissure. what is the difference, i don't know but i was not in any discomfort or pain post LIS. in addition, i had a big skin tag removed, and i also had lots of damaged anal skin removed due to condyloma. so i had lots of work done down there all at once.
***
if you feel you want to do something less invasive, then there is no harm in trying it.
if insurance will pay for it, go for it.
if it doesn't happen to work, then perhaps opting for LIS next will be your next step.
***
i'm all for less invasive ways but I couldn't escape having to get the condyloma removed and the skin tag took over my life towards the end more so than the chronic fissure.
all is very good now.
with regards to healing, i like to tell people that after just LIS, you need a good 2 weeks get back into the groove of things and about 4-6 months for the incision to heal inside properly. add another 4-6 months for you to feel mentally and emotionally normal and safe to go back to the toilet.
yes there are some complications and they may vary from person to person.
just inform yourself as much as you can about your options and then when you are ready, you'll know what to do.
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Re: LIS or SAD need some advice have questions

Postby flamingo » 03 Jun 2012, 09:06

Hello, and thank you for your resposes. I am just feeling so out of control with all of this. I much prefer the idea of SAD, but then my husband started questioning how if it is such a good idea, why can't we find anyone closer who does it.
Thanks for bringing up the insurance issue - I have to check into that - wonder if it is even a covered procedure.
And why do the surgeons that I saw that recommended LIS say that I can be back at work in a few days -- have surgery on Tuesday or Wednesday and go back by Monday; did I mention that I have a 1 1/2 hour commute --oh, that's ok, you'll be fine.
Sorry -- just needed to vent - this is all very stressful and confusing, and with a job, family, home and elderly parent to worry about - even the scheduling is overwhelming.
Thanks for listening.
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Re: LIS or SAD need some advice have questions

Postby jr2 » 03 Jun 2012, 10:29

Flamingo,
The reason SAD is harder to find is because in the US dilation fell out of favor due to an old procedure called a Lord's stretch which involved stretching the anus with the surgeon's fingers, a procedure that was very imprecise and caused more problems than it solved. Therefore, LIS became the gold standard procedure, even though it too has risks associated with it. The Lord's stretch is not the same procedure as standardized anal dilation being performed today by some surgeons who are offering it as an alternative to LIS. It dilates a specific amount for a specific period of time. It avoids the complications and risks of a surgical incision and has about the same rate of success with healing fissures as the LIS does. The reason it is not more widely available yet is because surgeons weren't trained in it and surgeons do surgery, which means they cut. Fortunately, there are some surgeons who wish to offer patients more alternatives for treatment of their fissures and we can only hope the trend will continue.
Health issues are always stressful and sometimes we all need to just vent. I hope you have a more comfortable day today.
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