When is a fissurectomy needed instead of just LIS?

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When is a fissurectomy needed instead of just LIS?

Postby Luka » 05 Apr 2013, 14:36

I haven’t had surgery, but it’s a possibility for me if my fissure doesn’t heal in another few months and I eventually get some health insurance. I’ve been reading through the surgery experiences on here and noticed some people only get LIS, while others get LIS and fissurectomy. I researched the fissurectomy procedure online and it seems like it’s something that’s only done when there’s a lot of scar tissue around the fissure. I’m just curious why they would cut it out since the fissure is already a wound. Do they just cut out and smooth the edges? Is it only for chronic fissures that have been there for years? Also, it seems like fissurectomies are discouraged by some CRS’s and only LIS is done (some consider it an old procedure and that it just complicates healing). I know there is often more pain with fissurectomy and LIS than just LIS alone, so this concerns me if I need surgery in the future.
You guys obviously know a lot more about this than I do, so I just wanted some clarification on the procedure since opinions are varied based on my research. It's just something I want to know in case I ever need to go the surgery route. Thanks for your help!
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Re: When is a fissurectomy needed instead of just LIS?

Postby hopefulbutt » 15 Jul 2013, 11:19

Just trying to give this a bump as I am wondering the same thing.
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Re: When is a fissurectomy needed instead of just LIS?

Postby Ever the Optimist » 15 Jul 2013, 11:53

Yes.........good question Luka!!!..............
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: When is a fissurectomy needed instead of just LIS?

Postby WelshDoubleFissure » 15 Jul 2013, 12:44

Hi guys.
My story is here about my double fissurectomy, skin tag removal & Botox.
http://anal-fissure.org/t6886-sharing-my-double-fissurectomy-botox
Short version - I had been suffering with pain whilst pooping for 3 years. First 2 years self treating hemmies. The next year I finally took my mum who frog marched me to the doctors. I was examined for hemmies but no luck in finding them. Prescribed lidocaine to try. No luck.
Another examination and finally diagnosed with possible fissure. Prescribed GTN (Nitro). Pounding headache for 5 mins after and a rash.
Returned to doctors still in pain and prescribed Diltiazem. To no avail. Then finally referred to a CRS. Long waiting list, lots of pleading and threatening to stop eating managed to get me in to see him. Was a rushed appointment due to it being slipped in before his appointments.
He did an external exam and saw skin tags which were indicative of fissures. Two of them.
He explained LIS is mainly suggested for men because then have a longer sphincter than women and therefore the risk of incontinence is higher in women. He said he'd perform an exam under anaesthetics (EUA) and see what needed to be done.
More than likely it would be a fissurectomy which as you said they will do on a chronic fissure ( unable to heal with creams) - cutting away the scar tissues - which cannot heal because of the stools & spasms - and also because scar tissue cannot heal once it gets to a certain point.
I imagine the procedure as... Bare with me on this analogy... Lady parts. The lady lips will never heal closed as the skin is not open to do it (just like scar tissur), if you cut away the lady lips a bit, and keep the legs shut, it's more likely to heal and close up.
Does that make any sense at all? Excuse my gross analogy.
So by cutting away the scar tissue, making the fissure "acute" once again, it has more of a chance to heal with creams. This is then supported with introduction of Botox (a kind of cream effect but way more productive) or LIS which is the next step up from Botox.
Some have Botox to support LIS too. I know I'd like them both if my Botox doesn't work, just to help with the BMs.
Does that make better sense? Again sorry for the vagina analogy.
WelshAnalogyQueen x
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Re: When is a fissurectomy needed instead of just LIS?

Postby hopefulbutt » 15 Jul 2013, 13:09

Thanks welsh. And how are you feeling? I am on my second round of botox. I felt much better with the first round as I have retorn worse this time. It seems not to be helping much. I don't have any skin tags. I am just wondering if it comes time for me to ask for lis if I need a fissurectomy or if I would heal with lis alone. Funny you should mention long canal as one of my Crsentipned that I have a very long canal for a woman. The fissure itself does not bother me as much as the constant muscle tightness. I can feel that the botox made me more relaxed but the place of fissure is still indented tight from that angry muscle. Hope to hear more of your healing.
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Re: When is a fissurectomy needed instead of just LIS?

Postby WelshDoubleFissure » 15 Jul 2013, 13:34

Hi hopeful,
Today I am on my 8th consecutive pain free blood free BM day. I poop everyday, mostly twice due to being on 3 movicols a day (but I feel it works well for me).
My first week sucked. But then the pain dropped from 10/10 to 5/10. 2nd week was bit of a bummer because the surgery caused me to start my period and I ha to stop my pill after 11 days to let it run its course which inevitably threw my poop routine out the way.
3rd week I swapped from Movicol (bought online) to Laxido - prescribed by GP but was effectively the same ingredients wise. But this again threw my bowels out of sync and caused blood on my stools.
Stick to what you know! I'm back on Movicol.
The Botox took about 2 weeks to kick in properly and 4 weeks in - its still working beautifully along with the help of Diltiazem.
So I feel really positive. I get the odd uncomfortable feeling after a BM, today I had a few twinges and itching but nothing compared to the first few weeks.
How long did you have a fissure? I hear that after 8 weeks it becomes chronic. But every case is different. Mine must've been extra chronic and the surgeon said it was a mess down there. But with the Botox I will have the bumhole of a 18 year old!! So youthful!
It's good to hear you have a longer muscle. I guess you'll be fine with LIS. My CRS didn't mention LIS at first because he hasn't seen my sphincter. So I guess after him doing my fissurectomy and Botox, he'd have more of an idea about the length of mine now. If this doesn't work then it's probably the next option for me.
Welsh x
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Re: When is a fissurectomy needed instead of just LIS?

Postby hopefulbutt » 15 Jul 2013, 14:07

Welsh. So glad to hear That you were healing well. I started With two fissures last February 2012. One is all healed. The other keeps retreating. I think I would be feeling great except for most recent retreat. I was actually a whole week into my botox when I felt it retreat. The botox kicked in a few days after that. I have been on miralax for a whole year now and bms are soft so I have no idea how I could have retore. I actually looked at the poo that did it and thought "that's it? That skinny thing? Had as much botox as she could give me-100 units. I do feel like I am making slow improvement. So maybe? I justs so sore sometimes! You know what I mean. Anyway. Just getting my mind prepared in case of lis. I am still using diltiazam cream as well.
Did u have bad muscle soreness too?
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Re: When is a fissurectomy needed instead of just LIS?

Postby WelshDoubleFissure » 15 Jul 2013, 14:48

Hi Hopeful,
When people were talking about spasms, I had no idea that this meant the muscle contracts and pulls the fissure apart which then brings the Razor blade feeling.
Pre surgery - I would psych myself up to poop, and I'd just push it out as quickly as possible, if I tried to do it gently, the pain would last longer so I'd get it out, deal with the pain and once the first stool passes the fissure, the pain would lessen from 10/10 to 3/10. My stools were relatively wide because of all the fibre I was being advised to consume - Poor advice in my case.
Lots of fibre = big fat poos and inevitably keeps the fissure open.
After 3 years, the pain after my BM's got gradually worse and my condition deteriorated. I couldn't sit for 15 mins after most of them. It took 3 whole years to get to this stage so I guess in the beginning, internally it would be sore, but no real difference externally.
Its funny because when I went to my GP the first time (3years in) I could let her examine me with no pain, even had a telescope up there. No pain.
Then after a year of cream treatment and a visit to a CRS, the pain was so bad, he could only look and part my cheeks carefully. It's crazy to think I developed an external fissure whilst trying to treat my internal one. Whether one caused the other or it was inevitably going to happen I don't know.
So to answer your question, early on, I was in no real pain apart from the BM.
Then it deteriorated and the pain became external.
After surgery once I had a BM I'd get a "booted up the bum" feeling that would last a good 5 hours but gradually decreased.
and 4 weeks in after a BM it just feels as if my bum hole is still pushing out and I have to consciously pull it back in with my muscles for 10-15 mins.
LIS must be a scary prospect, but so long as you've tried everything else, it might be a great option. Did you have an external and internal one?
Welsh x
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Re: When is a fissurectomy needed instead of just LIS?

Postby resume » 16 Jul 2013, 07:30

I had LIS and a fissurectomy last Wednesday. I had my fissure for 6 months so it had become chronic. I tried all of the conservative measures - sitz baths, more fiber, miralax, and nifedipine to name a few - but the fissure wouldn't go away. I finally saw a CRS (who had great reviews!) last month and he said I definitely needed the surgery since it's been going on for so long and there was so much scar tissue built up. Of course that was the last thing I wanted to do but I was desperate. I guess what he did was scale down the scar tissue, smooth the edges and cauterize the fissure to help it heal. He also did the LIS to stop the spasms and promote healing of the fissure.
There may be more pain than with just the LIS but it hurt worse on the bad days of my fissure. And it's very manageable with pain medication. My pain was maybe 6/10 at it's worst in the first few days and that was mostly from walking around too much. It's been 6 days and the pain is now 0-1.
I have not felt the fissure since the surgery. I do feel the area where he did the LIS but it is getting better every day. AND the best part is.. my bowel movements are nearly pain free! I do have to keep in mind that even though things feel almost normal, it doesn't mean I am healed. It takes 4-6 weeks for the fissure to heal and up to a year for everything to be "normal".
All I can say is that I wish I had done this sooner!
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Re: When is a fissurectomy needed instead of just LIS?

Postby hopefulbutt » 17 Jul 2013, 05:58

Thanks resume. I kind of wish I had pushed for lis instead I this second round of botox. She offered it but suggested more botox. I only had botox and its been a month. I am definitely sounding worse off than you. So glad you are healing! Gives me hope too.
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