MY SURGERY DIARY: LIS + FISTULA REPAIR

Have you had surgery for a Fistula and would like to share your success with others on the board who might be worrying about their surgery? This is the place, snd we would be happy to hear from you. Also, if you want to keep a Fistula diary, feel free to do so.

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MY SURGERY DIARY: LIS + FISTULA REPAIR

Postby thisfissurecankissmybutt » 22 Jul 2012, 23:47

Hi All!
I am scheduled to have my surgery tomorrow (my "slice and dice"), Tuesday, July 24th.
Wish me luck!
A brief history: About a year and a half ago, I decided to start running with my wife since she was starting to look much better than me in a bathing suit. We ran about 6 to 7 miles a day (that's not pertinent to the story, I just like to brag). However, one day (about 10 months ago) we ran way too far for way too long with far too little water and I became dehydrated. The next morning I went to the bathroom to have a bowel movement (BM) and out came a solid brick, a bowling ball, a 1967 Chevy El Camino (paint color? brown, of course) and Jimmy Hoffa. I was sweating and grabbing onto the sides of the toilet for leverage. I said a couple of Hail Marys (which is odd, since I'm not Catholic) and just prayed to God that I would die quickly.
The toilet became permanently clogged and we had to move. I'm sure some of you can relate.
After that BM, my butt immediately started to ache (and not in a good way). I never had any blood, just pain following a BM that lasted for SEVERAL hours. A couple of months later I went to a CRS who found, you guessed it, a fissure. He immediately prescribed Nifedipine. The fissure healed (yeah!), although it healed incorrectly as a superficial fistula (not so yeah!). My CRS discovered the fistula while doing an examination under anesthesia (EUA). He recommended surgery to "deroof" the fistula since it is rare that a fistula goes away on its own. In addition, he also recommended that I have a lateral internal sphincterotomy (LIS) at the same time as he thinks I am prone to having fissures (lucky me) AND he wants to make sure the fistula heals correctly.
So, I am having surgery under general anesthesia - LIS and a fistula repair.
A couple of pre-surgery thoughts that may be helpful to others (in no particular order):
1. Pre-surgery prep:
DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT THE NIGHT BEFORE THE SURGERY.
ON THE DAY OF SURGERY, USE A SALINE ENEMA AT LEAST ONE HOUR PRIOR TO SURGERY.
2. My CRS would like me to be on a "soft" diet for 5 days following surgery. I hope this includes soft drinks, soft-serve ice cream and soft pizza with mounds of extra-soft cheese.
3. For the past several months, I have been taking a daily dose of Miralax (one full dose every morning), which has made my stools nice and soft, like melted ice cream (yum!). My CRS has recommended that I keep taking the Miralax for life, along with a fiber supplement (he recommends Konsyl).
4. I have a follow-up with my CRS at two weeks and six weeks. He expects me to be nearly pain-free at two weeks and he expects a full recovery at six weeks.
5. My CRS said the biggest risk following surgery is infection. He said it is rare, but he does have a patient every couple of years that has an infection following surgery. If I do get an infection, he said it is a "simple" in-office procedure to take care of it. I'm guessing this means simple for him and painful for me. Let's hope I don't have to find out.
The symptoms of an infection: your butt will be red, swollen, you will likely have a fever AND (the key) each day things get progressively worse, not better.
6. My CRS gave me his personal cell phone number in case I have any questions following surgery. How cool is that? For $20, I'll give it to you.
7. The cost of the procedure is as follows (U.S.):
GENERAL ANESTHESIA - $350
LIS - $1,500
FISTULA SURGERY - $1,250
TOTAL COST = $3,100
8. Ironically, since I scheduled the surgery about three weeks ago, I have been 100% (100%!) pain-free. Go figure. Ten looooooooooooooong months of pain, I schedule the surgery and the very next day, NO PAIN. It's the longest amount of time I've gone without pain in ten months. My CRS said this isn't unusual, as for some people the simple act of scheduling surgery immediately relaxes their muscles which relieves their pain.
I asked him if I could just keep scheduling and then canceling the surgery for the next couple of decades, but he said it only works if you REALLY believe you are going to actually have the surgery.
Crap.
9. I feel like I should be nervous, but I'm not (although, at the moment, I am a little gassy). I think it's because I am just ready to get this chapter of my life over with. Of course, that may change tomorrow morning. My CRS did give me some Valium to take (10MG), if I needed it, an hour before the surgery.
10. My CRS has given me the following post-op medication:
CELEBREX 200MG, an anti-inflammatory - 1 CAPSULE 2X A DAY
BACLOFEN 20MG, a muscle relaxer - 1 TABLET 4X A DAY
FLAGYL 500MG, an antibiotic - 1 TABLET 3X A DAY
ULTRAM 50MG, a non-narcotic (i.e., non-constipating) pain reliever - 1-2 TABLETS 4X A DAY
My CRS has recommended taking all of the above medication for 10 days, whether I feel like I need it or not.
11. My CRS has recommended the following post-op clean-up following a BM for the first couple of weeks:
No wiping! No wiping! No wiping!
After no wiping, hop in the shower and use a removable shower head to thoroughly clean the area. Then, hop in the bathtub for a soak. Then, hop back in the shower and use the removable shower head to clean the area again. After all that hopping, use a hairdryer (on the COOL setting) to get everything nice and dry.
If needed, I can gently shove some gauze between my butt checks.
12. The surgery, not including the time to put me to sleep and wake me up, will take less than 30 minutes.
13. My CRS said post-op recovery is like a roller coaster: some days you are up, and some days you are down. He said the key is that you should be improving over time. He said to measure your healing in terms of a week at a time and not a day at a time, and not to be too concerned if you have an occasional bad day or two, as this is to be expected.
14. Since my fistula is superficial, my CRS has assured me that the recovery from fistula surgery and LIS won't be much different from the recovery for just fistula surgery or just LIS.
15. My CRS said I could start having sex again as soon as I felt up to it. Being a guy, I'm guessing I'll be up for it tomorrow night.
I will post post-op comments and observations periodically, for those that are interested.
P.S. A special thanks to Davo (if you are even thinking about having LIS, you MUST read his posts), Ever The Optimist and Sue27uk. I'll see you guys on the other side! Your posts have been VERY helpful in my preparation for surgery! GOD BLESS you guys and everyone else on this forum (especially jr2 - I hope you find a good CRS soon and get some relief)!
Last edited by thisfissurecankissmybutt on 23 Jun 2013, 22:12, edited 7 times in total.
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Re: MY SURGERY DIARY: LIS + FISTULA REPAIR

Postby Ever the Optimist » 23 Jul 2012, 10:38

Hi TKCKMB!
Will be thinking of you and waiting on your post op update. Sure it will be absolutely OK!!
Glad to read that you feel really positive and cheerful about it all. GREAT attitude and very funny post!
Great advice you've been given and just look forward to being healed!! (Pretty much everything I did too, especially with post cleaning....NO wiping or straining!!!)
Trust me, the Valium will make you feel great and totally take away any fears, so take it!! but I'm not too sure about being entirely pain-free after 2 weeks but who knows? We are all so different..........
As for point 15, that only took a couple of days or so post op.... LOL!
Will defo be following your progress and all the very best with it Image
Chronic Fissure diagnosed December 2011
Healed by Diltiazem around Feb 2013
Anal Fistula followed burst abscess in June 2012
2 internal troublesome piles remain & suspected, but undiagnosed, ongoing Levator Ani type symptoms & flare-ups
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Re: MY SURGERY DIARY: LIS + FISTULA REPAIR

Postby jr2 » 23 Jul 2012, 14:27

Hi!
Before I saw this post, I posted a separate "good luck" post! So, I'll double my good luck wishes to you here, and also thank you for the detailed information you provided.
Just one thought. Years ago I was given Ultram to try for pain. Other than making me really sick (which all painkillers do), it did cause constipation for me, which is weird since i struggle more with diarrhea. It could just be me as I always have weird side effects with drugs, but just something to consider.
And don't be surprised if the Flagyl causes you to have a horrible taste in your mouth that makes everything you eat taste terrible. I had to take it years ago. Some people call it a metallic taste, but it didn't taste metallic to me. It just tasted awful. It's a really common side effect though, so that effect you might get.
Again, all the best to you for speedy healing, being as comfortable as possible during your recovery, and a permanent end to your end problems!!!
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Re: MY SURGERY DIARY: LIS + FISTULA REPAIR

Postby thisfissurecankissmybutt » 23 Jul 2012, 18:21

Thanks ETO and jr2 for the well wishes!
I can't eat anything after midnight, so I am going to spend the next 3 1/2 hours stuffing my face. Bon appetit!
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Re: MY SURGERY DIARY: LIS + FISTULA REPAIR

Postby Badd825 » 23 Jul 2012, 19:59

I'm looking forward to hearing your post op success story. Your post made me laugh and cry. I laughed cause it was funny and I cried cause I cry at everything these days. My new awesome crs didn't see a fissure but did see an external hemorrhoid. My symptoms are consistent with fissures and spasms which is why I have an exam under anesthesia scheduled for next Friday. I consented to surgery if he thinks it is neccessary. I need encouragement and optimism. As much as I have found a lot of support here, I also have been petrified and discouraged by some of the posts. I look forward to yours because you sound very hopeful and positive and I believe that is crucial to healing and having a good outcome. Good luck to you and please keep us posted. As for the sex part, I'm a woman and will use this an excuse for at least 2 months!!!!
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Re: MY SURGERY DIARY: LIS + FISTULA REPAIR

Postby Sue27uk » 24 Jul 2012, 11:17

Thisfissure, its a bit late to wish you luck - I'm sorry!! But I hope all went well, I'm sure it will have done. I am glad my posts have helped you. I must admit I agree with ETO, no pain at 2 weeks is a bit hopeful but you may be different! I am still having good and bad days but hopefully getting there. I have given in and am having painkillers still, only ibuprofen once per day though. I think going to work last week kinda did me in!! Relaxing this week is much better. Look forward to hearing about your full recovery and here's to getting your life back! :D
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Re: MY SURGERY DIARY: LIS + FISTULA REPAIR

Postby thisfissurecankissmybutt » 24 Jul 2012, 12:25

Hi All!
I am home from surgery and according to my CRS it was a success! Once I am a little more coherent I will post my surgery experience. For now, I am going to take a little nap.
Thanks again for all of the well wishes!
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Re: MY SURGERY DIARY: LIS + FISTULA REPAIR

Postby andyk123 » 24 Jul 2012, 17:01

welcome to the other side! well done for getting it done.
i am day 12 now, and things are just starting to improve. the pain for me in the first week was quite severe, but it was the worry that it hadnt worked that got me down more than the pain, coz ive read alot of people who seem to be pain free straight away.
since then i have read a lot more peoples accounts and a lot of people have a slower recovery, so dont make the mistake that i did of stressing needlesly.
it sounds like u have a great CRS and have been told everything you need to know, so all i can say is good luck and hopefully u have an easy recovery!
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Re: MY SURGERY DIARY: LIS + FISTULA REPAIR

Postby thisfissurecankissmybutt » 24 Jul 2012, 19:50

Thanks again for all of the well wishes, guys!
As I mentioned above, my surgery is over! According to my CRS, it was a success.
Here's how it went down:
DAY 1
I had a good nights sleep last night and woke up this morning around 6:30 AM. After having a BM, I administered two enema's (about 30 minutes apart).
Even though I wasn't nervous, I went ahead and took 10mg of Valium around 8:15 AM.
I arrived at my CRS's office at 9:15 AM. The admitting nurse gave me a hug and welcomed me. She took my blood pressure and asked me if I had any questions (I didn't). Surprisingly, they didn't require me to have any pre-op blood work done, presumably because I am fairly young and healthy.
I went to the bathroom one last time and changed from my clothes into an anything-but-sexy gown that showed everyone all of my business. I felt like a walking peep show. Unfortunately, nobody stuffed any dollar bills in my gown.
Around 9:30 AM, the anesthesiologist came over and introduced herself. She explained the process (she was going to be using Propofol), inserted the needle (which was painless - she used a pediatric needle), assured me that she would stay with me during the entire procedure and asked me if I had any questions. Since she explained everything so well I didn't have any questions, so we just talked about our kids, etc.
Around 10:00 AM, my CRS came by to say "hi." He reviewed what he was going to be doing (a fistula repair on a superficial fistula and lateral internal sphincterotomy to make sure the fistula heals correctly) and asked me if I had any questions or concerns. I asked him a few questions and around 10:15 AM they rolled me back to the operating room.
I removed my gown in front of a room full of nurses and they positioned me face down on the operating table with my butt in the air. They asked me to get comfortable and within seconds I was completely out.
The surgery took less than 30 minutes.
They wheeled me back to my room (which I don't remember) and within a couple of minutes I woke up. When I woke up, I was completely awake and coherent and felt great.
My CRS stopped by a few minutes later to talk to me about how everything went. First, he said he repaired my superficial fistula. The fistula was about 4mm long and wasn't very deep. He basically deroofed the fistula and stitched down the excess skin (using self-dissolving stiches) creating a valley which should heal from the bottom up.
In order to make sure the fistula heals correctly, he also performed a lateral internal sphincterotomy (LIS). There are several different LIS techniques. My CRS takes a very conservative approach and performed what is referred to as a closed technique. Basically, he makes a small incision at the intersphincteric groove, inserting a scalpel (size #15) with the blade parallel to the internal sphincter and then he rotates the scalpel towards the internal sphincter, dividing it. The actual incision is very small. He also put a single, self-dissolving stitch in the incision site.
My CRS said I would probably be pain free for 4 to 6 hours, due to the medication they give you during the surgery. In the meantime, he told me to go ahead and start taking my medication.
They didn't put any packing into my anus (thankfully!), just some gauze between my butt cheeks. I haven't removed it yet, but I am planning on removing it later tonight when I take a bath.
My CRS said a year from now he probably won't even be able to tell I ever had surgery. Shortly after, we said our goodbyes. I will go back to see him in two weeks, unless I have any issues in the meantime.
Following surgery, they want to make sure you can urinate, so I went to the bathroom and was able to urinate immediately.
A few minutes later they told me I was ready to leave! I gave everybody hugs, paid my bill at the front desk and gently hopped into my car. Although I wasn't allowed to, I probably could have driven myself home.
After my surgery, my wife and I went out to lunch. As my CRS had predicted, I was pain-free, but I did sit on my cushioned pillow. After lunch I ran a half-marathon and put a new roof on our house (just kidding, of course). However, about an hour ago, I did take a short walk around the block. The last thing I want to do is lay in bed all day and get constipated.
My surgery was about 10 hours ago, and here are my thoughts so far:
1. I have had a little gas, but it has been silent and effortless. So far, I haven't had any excessive leakage.
2. For the past couple of hours, despite taking pain relievers (Ultram and Celebrex), as well as a muscle relaxer (Baclofen), I have been in some pain. It is definitely different than the pre-op pain. It is more of a dull, sore pain with occasional sharp twinges. On a scale of 1 to 10, I would put it at a 1 or 2 at this point. Without the pain medication, I'm certain it would be much worse.
3. I took a full dose of Miralax immediately following surgery to make sure everything stays nice and soft.
4. Since the surgery, I have been eating regularly and drinking lots of water. I want to make sure I am eating enough food to stay regular and drinking enough water to keep everything nice and soft.
5. I'm hoping to have my first BM in the morning (my normal schedule) but my CRS said it could take three days to have one. If I haven't had a BM in three days, he wants me to start taking Milk of Magnesia. I'm crossing my fingers that the thought of the BM is worse than the actual BM.
6. I am VERY disappointed that my CRS did not send me home in a sexy pair of fishnet underwear that so many of you received after your surgery.
7. For those of you who are considering surgery, I can say that the actual surgery was a breeze (and remember, I had TWO procedures). And while I am obviously uncertain of what the next days and weeks hold in terms of my recovery, I am absolutely confident that having surgery was the right decision for me. Although no one wants to have surgery, especially on their butthole, I can say with absolute confidence that the thought of surgery is much worse than the actual surgery. My only regret is that I waited so long.
I will update my progress tomorrow. Please let me know if you have any specific questions and I will try to answer them.
Thanks again for all of the thoughts and prayers!
Last edited by thisfissurecankissmybutt on 29 Jul 2012, 14:20, edited 2 times in total.
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Re: MY SURGERY DIARY: LIS + FISTULA REPAIR

Postby Davo » 25 Jul 2012, 05:24

Glad to see you're doing well and I wish you a speedy recovery.
If i was to give you two bits of advice post surgery it would be:
1. Dont Strain - And i am not just talking about during a BM - straining to lift something heavy or to remove a tight bottle top, etc. has the same effect as straining during a BM so take it easy for a few weeks.
2. Exercise - As soon as you feel well enough to do so get back on your feet and take a brisk stroll in the park. It gets the blood flowing which promotes healing and improves your state of mind.
Looking forward to reading that final 'Im healed' update
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