LIS in 2014 now fistulotomy in 2021

Fistulotomy

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LIS in 2014 now fistulotomy in 2021

Postby PNW » 30 Dec 2021, 01:26

Prologue: Developed fissure in Nov 2013, tried diltiazem and nitro to no avail. Had LIS in Aug 2014 after a grueling summer of pain. Here's the story until 2016: lis-worked-t9836.html

Update to 2021. No regrets getting the LIS surgery, no fissure pain since 14.

Caveat: I can get anxiety if my guts start moving in public. I need to be near bathroom or be in the woods with TP. Sitting down usually squelches the urge, or doubling over when standing. Only three accidents since that surgery, one was with diarrhea while driving, and two were from waiting too long.

Fast forward to October 25, 2021. Feel small swelling on outside at 12:00 near tailbone, pea sized gets bigger during the week. A little itchy. Early November, gets painful, eventually drains, smells funky, need pad in drawers. Went to my GP, he had retired, get young doc. Says it's hemorrhoid. Ask for referral to gastroenterologist who did my Colonoscopies. They don't do "hemorrhoids" lose a week. I suspected abscess to both GPs.

Nov 17, went to urgent care, young doc diagnoses hemorrhoid, prescribes Flagyl and oxycycline which clears up drainage after 10 days. Get referral to CRS that performed LIS in 2014, see him 12/7. Took one look says:"...you got a fistula buddy." He thought it was a very simple one, schedule surgery for today, 12/29.

I was very anxious about bowel control, he didn't think it will be an issue. Everything I've read says that fistulae don't resolve themselves. Mine started to drain some dreadful smelling stuff, for the last two weeks, needing padding in underpants.

I plan to keep a log, but may not update this every day. I'm taking off two weeks from work, which may morph into working from home.

This forum is a great resource and I want to share my experiences.

Tom E.

Day 1 BM at 800, shower and handheld showerhead to clean. Surgeon's office at 10:00, no prep other than no food or drink midnight prior. Into operating room at 10:33. Propofol iv with some narcotic, prone position for surgery. Into recovery room by 11:10. Local administered before surgery, gauze between cheeks after. Local wore off by 11:45 in car for 40 min ride home. Took two ibuprofen in the car. Little pain after ibuprofen kicked in. 3:30 pm, gauze getting soaked with exudate, rose colored. In recliner, not super painful. Dr prescribed hydrocodone/Tylenol 5/325, and Recticare lidocaine gel. Will try without, but have it for backup. Simple fistula, unroofed, sutured with dissolving stitches, no packing necessary. Dr said 4-6 wk recovery, follow up on Jan 11. Said no food restrictions, keep it clean. Sitz, showerhead. Took two more ibuprofen at 7:30 pm. Sitting in recliner all day with some breaks to walk. Feeling pretty good so far.
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Re: LIS in 2014 now fistulotomy in 2021

Postby PNW » 31 Dec 2021, 19:23

Day 2, Dec 30 Slept from 2:30 AM-9:30, took 2 ibuprofen at 9:30. Changed gauze dressing between cheeks at 4 hour intervals. Mostly rose colored (looks like watery blood) drainage, semi-funky smell. Drsaid to expect drainage. Had false alarm, but no BM, only gas as of 10:30. Took shower, pat dry new dressing. Took 1 Colase at 10:30 PM.

Day 3, Dec 31. 1st BM at 10:45 AM average, no pain. Handheld shower head, new gauze pad. Slight sting afterward. Sitz bath for 15 min to try and clean, worked well. 2nd BM almost immediately after sitz bath at noon. Used folded TP with witch hazel to clean left side, removed bulk of the stool. Colase keeps it soft; no pain. Then back into shower with hand held shower head. No pain, feeling pretty good. Some drainage.
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Re: LIS in 2014 now fistulotomy in 2021

Postby PNW » 04 Jan 2022, 05:42

Day 4, Jan 1. Slept late, 10:30 AM. Some slight drainage on gauze. BM at 2:30 PM, okay. Folded TP moistened with witch hazel, then hand held shower. No pain, slight sting prior to shower. No ibuprofen yet. 2nd BM at 9:30 PM, shower and sitz bath. No real pain.

Day 5, Jan 2. Not much to report. Took it easy, no ibuprofen or other analgesics. Drank water and relaxed. No BM until 8:30 PM. On the large side, still taking one Colase per day. Felt it a little but no blood, slight stinging afterwards. Took shower using Water Pik hand held showerhead. Slight drainage during the day, but seems to be a little less. Mostly watery with some tinge of red. Still smells a tad funky though. May take sitz bath before bed. 2nd BM at 10:30 PM, another shower. Felt it a little more. 3rd BM at 1:30 AM and another shower. Woke up some internal hemorrhoids, still not too bad

Day 6, Jan 3 No pain, no BM, but this is normal for me. Got kind of cleaned out yesterday. Took sitz bath in the morning to clean things up. Slight discharge throughout the day, nothing major. Clean with TP moistened with witch hazel throughout the day as well.

Everyones experience will be different, but so far it has been much better than I expected. After my LIS seven years ago, I took hydrocodone for a couple of days; no need so far.

I certainly hope I can consider this a success story. I see my surgeon on 1/11 and I'll get specifics on the procedure. Some of the stories on this forum gave me some anxiety, and some were reassuring.
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Re: LIS in 2014 now fistulotomy in 2021

Postby PNW » 12 Jan 2022, 07:06

Day 7, Jan 4. No BM, no pain.

Day 8, Jan 5. Small BM at 8:30, shower head. Larger BM at 12:00. Shower head then sitz bath for 10 min.

Day 9, Jan 6. BM 9:30, (small) shower head. BM 12:30, (med) shower head. Some drainage.

Day 10, Jan 7. No BM, some drainage. Worked on snow blower in garage sitting upright. Little drainage afternoon eve.

Day 11, Jan 8 BM at 4:00 pm, no pain, handheld showerhead, little drainage. Another at 9:30 pm another shower head. Some gas incontinence.

Day 12, Jan 9. No BM, some slight drainage. Funky smelling, like before surgery.

Day 13, Jan 10. Drainage foul smelling in morning, slight though. BM at 10:30 pm, okay

Day 14, Jan 11 BM 8:30 then shower head. BM 11:00, shower head then sitz bath. Slight drainage.

Two week follow up appointment. Dr. said incision was 1" long, half inside, half outside and was healing well after 2 weeks. No external muscle involved, small amount of internal sphincter. He said to expect some drainage for up to 6 weeks. Smell not due to infection, just bacteria feeding on the exudate. He said I could go back to usual bathroom routine soon

I probably won't be posting for a while. My situation seems to be under control. I have a follow up visit on February 8th. I took two weeks off from work and took it easy. I'll be transitioning back to work on the 12th.
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Re: LIS in 2014 now fistulotomy in 2021

Postby PNW » 21 Jan 2022, 03:47

Jan 20, three weeks and two days post surgery. At the two week follow up appointment, Dr. said I can go back to regular routine. I've been feeling pretty good so I've transitioned to usual dry TP after BM. I usually try to go before shower and clean up with shower head. I have no external wound though I am still "treading lightly." High quality TP makes all the difference. For the US folks, I suggest Costco brand. It is far superior to the institutional brands at work!

Throughout the day I am still getting some drainage from the internal incision (presumably) and Dr. said to expect it for a couple more weeks. It does seem to be declining. I have to check and clean with TP a couple times a day. Still wearing a liner in my shorts with some TP on top.

I have to say that since the "architecture" down there has changed due to the incision, stools are wider and oval in cross section. I have had some gas incontinence, nothing embarrassing in public. No real change with stool incontinence since the LIS surgery: when the urge starts, I need to be near a bathroom, or sit down until the urge passes.

Overall, I'm pleased that I've healed so quickly. Not knowing how bad it was before the surgery and reading the stories from others' bad experiences definitely caused some anxiety. My surgeon is the only one in the Spokane WA area that is a CRS. He told me that he does 3-4 per month. I would urge folks going through this to get an experienced CRS. He fixed my fissure back in 2014. I hope that my 6 week follow up is the last time I have to see him professionally.
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