http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4079811/
"Six hundred and twelve patients (303 women: mean age, 39 years; range, 16-86 years) were treated for chronic anal fissure between 1998 and 2008. Topical diltiazem 2% was initially prescribed for 8 weeks. The fissure did not heal in 141 patients. These patients (61 women: mean age, 30 years; range, 15-86 years) were treated with 100 IU botulinum A toxin (Botox) injection combined with a fissurectomy under general anaesthesia. Thirty eight patients suffered a recurrence of their fissure within two years. Thirty-four healed with further medical or sphincter conserving surgical therapy while four required a lateral internal sphincterotomy."
....So if I'm reading correctly from this particular study - from 612 chronic anal fissure sufferers, 77% healed from diltiazem (applied for 8 weeks). From the 23% that didn't heal, 73% were healed (for at least 2 years) after a botox injection and fissurectomy. From the 27% still not healed, 89% were healed after further medical or sphincter conserving surgical therapy (whatever that was). 0.006% of people didn't heal from all that and 'required' an lis.
I'm really not sure on the value of botox (I'm trying to decide between botox and lis). It seems to have good success rates but then I'll read about someone who had botox and had nerve damage or something from the botox. On the other hand, sometimes incontinence and reported as being quite high after an lis (like 20%? i hav no source) and others claim its really low (like 3%) or something.
LIS:
- "persistent incontinence to gas occurred in 30 percent" http://www.ncbi.nlm.nih.gov/pubmed/15906136
- 10.2% were left incontinent http://www.ncbi.nlm.nih.gov/pubmed/16007364
- 8% incontinent to stool (refer next two paragraphs for source).
I'm also quite sceptical about surgeon's data. From the book titled: "Reconstructive Surgery of the Rectum, Anus and Perineum" (see https://books.google.com.au/books?id=ec ... ce&f=false):
It mentions a theory that surgeons construct their surveys in a way that reduces the number of people reporting incontinence. It states "A review of patient notes after LIS reported gas incontinence in only 4.4% of patients and stool incontinence in 2.8%, whereas an annonymous questionnaire completed by the same patients revealed a much higher rate of gas incontinence (31.5%) and stool incontinence (28.7%)". HOWEVER, it then goes on to say "symptoms persisted at 3 months postoperatively in 30% for gas incontinence and 8% for stool incontinence". So I'm assuming this means that 3 months after the surgery, 8% were suffering from stool incontinence (still much higher than the 2.8% they reported).
Anyways, this post may become a place to copy and paste key stats on fissures to construct a true representation of things. One thing about this forum is that it will generally attract those currently suffering from a fissure. Most people who are healed and have been healed for several years probably won't visit this page and this can severely skew our perception of success rates, etc.
So if you feel like doing some research, feel free to paste it here.