*ughhhhhh , that is really tough and I am sooo sorry to hear that you are in such rural area and do not have much choice in doctors and procedures !!!! NOT FAIR !!!!!!
Listen, this is what I would probably do if it was me, but please understand that we are all different and this is just me trying to help with some exchange of ideas - I wish I can help you more : ((((
I agree that LIS would probably help with fissure itself ! And that is not "small " issue !!!!! Fissure sometimes does not hurt much (some people luckily do not have extreme, cutting, searing pain with fissure ), but me personally would constantly worry about possible infection and fistula forming and would do everything possible to heal it even if there was NO pain
Now, if your fissure is causing even more pain for you than LIS will help you with local spasms as well as fissure pain and local irritation which can be really big deal as well !!! I had second LIS just to get rid of that part - fissure occasionally and constant irritation of anal mucosa (burning, itching, redness , etc. ) - I just did not want to deal with stupid butt - PERIOD !!!! But, as you can see, I had very little patience for all of that nonsense happening to me and wanted to get rid of it - no matter what !!!
Now, somebody else might act completely differently You just need to make decision that seems the best for you personally - what are you ready to do , how much you are ready to put up with, what risks are you ready to take, etc. etc.
If you had amazing doctor and top-notch CRS, I would perhaps "push you" somewhat to "try" LIS and see if it helps, but to be honest with only one certified CRS and one general surgeon that you did not even have chance to meet and did not examine you, I am somewhat guarded and would actually suggest you see another CRS even if that means traveling little bit further and the ultimate BEST would be if you could visit some teaching hospital that has whole team of doctors that specialize in PFD
If that is not possible, than at least ask for "third opinion". I am especially upset that you do not have access to Botox since perhaps it can help with your PFD issue :roll: ( I will have to Google that !!!!!).
Regarding "extreme risk of incontinence" - where the heck did he find that stat. ????? It is VERY VERY LOW , I saw 5 CRSs and ALLL confirmed that it almost never ever happen and NONE of them had it happen, not in 30 and 25 years of practice respectively !!!!!! They all said that literature usually refers to "gas incontinence" which is also very, very rare !!!! DO NOT do LIS with that CRS who said that - maybe HE has so little experience with LIS or maybe he had a mishap himself with a patient - just do not go to him.
Also, did ANY of doctors that examined you see a fissure ??? If not, it still does not mean it is not there ! It happened to me before my second LIS - nobody could see it but all of the symptoms were there. I finally found CRS who told me that fissure can be easily hidden in one of the NUMEROUS folds and lo and behold that was the case !!!! He performed colonoscopy and made photo of my fissure to show me the "beast" - it was there VERY visible on a photo !!!
Please try to get that third opinion - it would be the best to have some more exams and more expert opinions before you go through LIS. But if you have no other option, than perhaps , have that LIS and "try" to see if it will at least take off the edge of you pelvic issues but only with CRS who tells you that he NEVER had incontinence happen to his patient !
I hope I was of any help *sigh, I so wish I can find you better doctors
Still never loose hope !!!! This only means that you just need to be more persistent in search for help : ))) !!!!