Surgery information (LIS)

Are you having, or have you had a Lateral Internal Sphincterotomy (LIS)? Please share your experiences here, or ask any questions.

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Surgery information (LIS)

Postby Deleted User 5 » 14 Jun 2009, 15:35

Here is a place for anyone who would like to give basic information about general questions about LIS surgery -- so you LISer's on the board may wish to add to my comments..
Please do!
This is NOT intended as professional medical advice, just experience from those who have had the surgery.
Last edited by Deleted User 5 on 14 Jun 2009, 15:55, edited 1 time in total.
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Re: Surgery information (LIS)

Postby Deleted User 5 » 14 Jun 2009, 15:54

When will I need surgery? Only you can answer that. Not us, not your surgeon or GP...most likely it will be when you decide you have had enough. I will say that the longer you wait, the more scar tissue will probably accumulate around the fissure and it will get harder and harder to heal. I would think anytime after 3-4 months would be time enough to consider it. But your pain and your quality of life will be the real determinants. I waited for seven months and then finally had it done and wished I had done it months sooner.
Will LIS make me permanently incontinent? It can, but the probabilities are low, anywhere from .01 to 2% depending on the source. No one who has posted here has ever become permanently incontinent. So far... but some mild transient incontinence is more likely in the days and weeks after surgery, but still the odds are low. You may initially have some difficulty in telling between gas and stool *on occasion!* I had only one episode of incontinence and it was a couple days after surgery and I had taken laxatives....
You may pass gas unexpectedly for a few months after the LIS but as a rule that is temporary too..you sphincter just needs some time to readjust and your anal canal will suddenly be somewhat looser after the surgery.
During LIS, do they cut my fissure? No, they will create a small incision into your sphincter to relieve the pressure within your anal canal so blood can resume flowing adequately to your fissure site so it can heal. A fissurectomy, on the other hand, does involve surgery directly at the fissure site.
How long before I can return to work? I was told (and thoroughly believe) that one needs 2 -3 weeks recovery. Remember, this is *surgery* and don't expect to be back at work over the weekend, though some people actually are, and some surgeons insist their recovery rates are faster. But for the most part, from experiences posted here, it takes 2-3 weeks at best. I was able to return to work after about 1 1/2 weeks.
How painful is the surgery and recovery? The first couple days after surgery can be rough, but most people state they are just really sore down there and the pain is not comparable to their fissure pain. My worst pain was in the minutes after I awoke from my suregrya nd I was given strong painkillers that took care of that.
How soon before my fissure heals after surgery? It will take at least a month for the primary healing to occur and you say, "Wow, I feel normal again." But there are so many variables, e.g. the size of the fissure and the amount of scar tissue around it's edges, hormonal fluctuations, etc...
Then it will be a year or longer before the fissure heals completely to the point where you really *are* back to normal and don't just feel normal... i.e. your membranes at the fissure site have regained their integrity completely. But this would hold true regardless of how you heal, through surgery or any other more conservative treatment. So during that first year after healing, you should keep your stools soft and stay regular, and bleeding from time to time should not be worrisome as your tissues slowly return to normal. But within 1 - 2 months after surgery *most* people feel pretty normal.
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Re: Surgery information (LIS)

Postby cherylk » 26 Mar 2010, 15:05

Maybe those of you who have had LIS could each post your summary here in this sticky thread that Kim created.
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Re: Surgery information (LIS)

Postby StevePain » 09 Aug 2010, 12:33

I had Lateral Sphincterotomy and Fissurotomy on Wednesday 4th August 2010 after suffering with a Fissure for 2 years.
For me, surgery was the last option but I reached the end of the cream and ointment road some time ago and wasn't prepared to let this bad boy rule my life any longer, I knew my Fissure was chronic after reading various articles about Fissures online, I'd had it so long and repeated tearing and partial healing only made it worse, I probably could of healed it in it's acute stage if I only I knew how to, I found this forum a little too late but better late than never, It's a valuable source of knowledge and information, I will never stay away from here for too long, even when healed
My GP never really gave any real advice about Anal Fissures infact it's fair to say that most GP's are uninformed when it comes to rectal problems like these, in saying that, so are some Colorectal surgeons!!
Anyway, back to the surgery, I was admitted to hospital as a day case (which means I go home after the procedure - all being well) I went to theatre at 11:44 am and was woken up at around 13:15 ish give or take some minutes (I was still drowsy), there was no pain just a bit of discomfort and was given some biscuits and a cheese sandwich!! CHEESE!! most of you will know that dairy is bad for fissures especially cheese... Jeez!! the only good thing was that it was on wholemeal bread so they was half way there, right? Image anyway after I'd eaten and had a drink I was sent packing with some Ibuprofen, Metronidazole and was advised to take paracetamol for pain relief, they're having a laugh right? Image oh and for good measure they advised me that I had some kind of packing shoved up my.. Image and that it would pass with the first BM... Image So off I went, got home and the anaesthetic had virtually worn off, that's when the pain started Image I somehow struggled through to the next morning on just Ibuprofen and Paracetamol as pain killers, it was the next morning that I had the urge to go Image so I sat there and something fell out, it didn't feel like Image and it wasn't, it was the packing I was told about.. Image then came the pain.. :( nobody had prepared me for this, it was agony and cleaning up after BM was very hard I knew I needed stronger pain relief so got some Dihydrocodeine but even this wasn't getting rid of the pain, Don't get me wrong, I knew there would be post-op pain but not as intense as this, In the days to follow I had multiple BM's that caused severe pain that lasted most if not all of the day, even sleeping was disturbed because of the spasms, I'm now only 5 days post-op and still cannot sit down at all but things are slowly improving and it is slow, believe me, I'm finding it a little easier to clean up after BM and the pain is less but don't underestimate how slow recovery actually is, just stay vigilant, stick with the high fibre diet with plenty of water and Movicol/Miralax, take sitz baths religiously and think positive.
Good Luck! Image
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Re: Surgery information (LIS)

Postby greeklion » 26 May 2012, 00:41

I am glad to have had the LIS surgery. I had never had sedation before and the hardest part for me the first 2 days was the nausea. I didn't know to tell them to give me a patch and I was miserable. Once i got pass that the pain has been improving rapidly each day. As I write this I am only 8 days out from surgery and can honestly say i am almost "normal" it is a bit hard to tell if the pressure I feel is just gas or a bowel movement but I expect that will improve. Either way I have been able to hold it until I could make it to a toilet and it hasnt been an issue. I have sat at the table and had dinner (which i couldnt do for the 6 months leading up to my surgery) and I have been able to get out run errands and do most things. As i said I am just a few days out of surgery so I am still taking it easy. The bottom line I am on the road to recovery and have no regrets. I lived with this problem for too long and only wish I had known about options or at least this forum! My general docotor was of little help with this issue he had me under treatment for a yeast infection then told me I might have cancer then another doctor gave me hemerhoid treatment without even looking and sent me on my way. Finally I then found a nurse that had heard of this and referred me to a coloproctologist (technical name?) Life is good now I hope it continues to be!
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Re: Surgery information (LIS)

Postby Lauren12 » 21 Sep 2012, 12:57

I finally had a lis after being in pain with a chronic fissure for two and a half years. I'm posting my experience here because it varies slightly from the standard case and if anybody with similar circumstances reads it, it may prove helpful.
I had a major fissure, but it healed spontaneously over several months, using Diltiazem cream. The thing is, I was still experiencing disabling pain (laying in bed for hours after a bowel movement), even though the major fissure had healed. I saw a specialist and had two lots of Botox into the anal sphincter, which didn't take away the pain. I kept being told by the doctors I saw at the hospital, which specialised in conditions of the lower bowel, that I had a perfectly normal anus. I began to feel like they thought I was complaining unnecessarily and was imagining the pain. The consultant even referred to "idiopathic pain", which is pain from an unknown cause, which really distressed me, as I felt that even the specialists didn't know what was going on. They planned to refer me on for biofeedback. At no point was the LIS operation mentioned to me.
At this point I took myself to see a different colorectal surgeon and the difference was as night and day. He knew exactly what was going on, and how to fix it. I had the LIS operation and am now back to normal. No pain. I had still been having muscle spasms, despite my major fissure having healed, and my anus had become so tight with repeated spasms (any muscle when repeatedly exercised becomes larger and stronger) that I was getting minor fissures with most bowel movements. In addition, I'd been in pain so long that a pain cycle had started between the anus and the brain, in that minor fissures which wouldn't be painful to someone who hadn't had two and a half years of pain were felt by me as highly painful, which caused further muscle spasms. This colorectal surgeon was able to see the minor fissures that were repeatedly occurring with bowel movements that the other surgeon had missed!
Anyway, he recommended the operation and I leapt at the chance. Afterwards, when cured, I asked him why this operation hadn't been mentioned to me by the previous surgeon, when it was so obviously the right cure for me. He said that medical orthodoxy (in the UK at least) was that if someone had a healed fissure, they weren't referred for the operation but that some people needed it, even so.
I'd also read accounts of people having had the operation and recovering in a matter of days or weeks. My recovery took months, so I'd just like to say to anyone who may have had this op and who wonders why they're still getting pain, that it doesn't mean the operation wasn't effective. It may just be taking longer for their anus to get back to normal. Always refer back to your surgeon however, if you're worried about anything post op, of course. In my case the pain cycle had to gradually downgrade until eventually I had a normal level of sensation in the anus. The surgeon said that the anus is a delicate piece of the anatomy and can take a while to settle down when something disrupts it.
It was also unfortunate in a way, because the LIS used to be the only medical treatment for anal fissure. In recent years however, other treatments have been devised, like the creams, and botox injections to the internal anal sphincter. It seems that surgeons will often try more conservative treatments first, thus lengthening the whole recovery process for that proportion of people who really do need the operation to recover. I could have recovered a year before I did had I not gone through the whole process of starting with conservative treatments, and had I had the LIS within months of the fissure first occurring. Unfortunately, two and a half years of being virtually immobile in bed for much of the day after bowel movements had a knock-on effect of muscle atrophy and I lost much of the strength and flexibility I had before. I didn't bend down for two and a half years for instance because it hurt. When I started trying to get active again once recovered, I tore a back muscle, because the muscles were weak, and developed various joint injuries because the muscles were no longer elastic enough to take the impact of various movements and the impact caused minor trauma to the joints. This is what made me angry that the whole recovery process was so drawn out. I would have jumped at the chance to have the operation within a few months of the fissure developing, had that been recommended to me, and I would have been back to normal so much sooner, thus minimising the knock-on effects to the rest of my body.
So in conclusion I just want to say, don't despair if you've seen a surgeon but appear to be getting nowhere and are still in pain. See another one if you have no faith in the one you're seeing - or still another. I saw three consultant colorectal surgeons and only the third had the understanding and skill to cure me - and with an operation that's been around for donkey's years.
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Having LIS -- Nervous!!

Postby IMPERFECTASSHOLE » 05 Oct 2012, 14:11

After 3 years of on & off suffering I scheduled surgery for 10/12. My main concern is recovery time. My Dr. says between 7-10 days. I have a wedding to attend on 10/20 & a Broadway Play on 10/21. He said I'll be fine to go to both---On this forum I've read recovery times from 3 days to 3 months. Any words of wisdom from surgery survivors?
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Re: Surgery information (LIS)

Postby barbedbutt » 22 Oct 2012, 07:03

I think it depends on what type of lis you had. I had open lis and the wound is still no where near healed after 2 months. And sitting for more than 2 hours really hurts. So lower your expectations and let the people close to you know your going through something very tough at the moment and they need to be patient.
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Re: Surgery information (LIS)

Postby StevePain » 22 Oct 2012, 14:01

I had LIS and Fissurectomy 2 years ago and am still not 100% pain free with re-occurrences now and again
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