I had my 12 week GTN follow up appointment with my CRS this evening and i have a few things to tell you...
Firstly let me tell you about my CRS - He works on Harley Street in London, is the Chair of Surgery at one of Londons top hospitals, is director of the GI unit at UCLH, is a senior lecturer of Colo Rectal surgery at one of the top London universities, he is a trainer of surgeons and he represents the UK at overseas colo rectal conferences. So the guy is pretty experienced in his field!!
GTN - Firstly if you dont see any results within two weeks its probably not going to work for you. For those that are going to heal with GTN, they will normally do so within 6-8 weeks. The human body actually gets used to the GTN and therefore its effectiveness wears off as the weeks go by so by 8-12 weeks re-tears are very common as the GTN is hardly effective anymore (that was my problem)
BOTOX - The difference between GTN and Botox is that GTN wears off during the day in between applications whereas Botox keeps the sphincter constantly paralyzed. My CRS has just returned from a conference in Florida and the majority of CRS's agreed that Botox injections are no more effective than GTN - My CRS said if it was him he would not even consider having Botox as patients can suffer gas incontinence, they can get infection/pain from the injection site and the few who do heal generally return after the Botox has worn off. He personally thinks that the Botox procedure will no longer be used in a few years time as GTN just does exactly the same job - he only recommends it if you find it difficult to apply GTN or if you are forgetful about applying it each time
LIS - Offers between 95-100% success rates and full pain relief can be experienced in 2-4 weeks, the chances of recurrence are virtually zero. However he says it is extremely improtant to choose your CRS carefully as some almost guess the length of the cut required (he lines it up by sight with the length of the fissure). He said Sphincterotomy has got some bad press over the past few years with incontinence being quoted at 10% - this is apparently related to Sphincterotomy rather than LIS which has less than a 1% chance of incontinence. He said he has performed 1000's of LIS procedures and not had one report of incontinence. He did unfortunately say that incontinence is more common in females due to the differing sphincter characteristics between males/females (sorry ladies! - however the risk is still less than 1%)
So i am scheduled for LIS in two weeks time and to be honest i cant wait!
Davo