When to go for Surgery?

Are you having, or have you had a Lateral Internal Sphincterotomy (LIS)? Please share your experiences here, or ask any questions.

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When to go for Surgery?

Postby Strangeworldaf » 01 Aug 2012, 20:55

Here is what my understanding about when to go for surgery but my today's appointment with my CRS(first Appointment) has lots of disappointments about the this particular CRS, cause in my first meeting he booked me for a LIS surgery.
My Study / Understanding based on my Fathers input (who is also a surgeon).
Step 1: First line of treatment: Lots of fiber, water, Sitz bath and rest. ( 1 week) >> if this fails to to step 2
Step 2: Nitro, Diltiaziem cream, or any vasodilator(refers to the widening of blood vessels resulting from relaxation of smooth muscle cells within the vessel walls) and Sitz bath , lots of fiber, water and good sleep. (3 to 5 weeks)
Ste 3: Botox Injection with Sitz bath, Fiber, Water and Nitro or Diltiazem
Step 4: LIS (Open or Closed) Preferebly Open as its more visible to the surgeon and he can see what is cutting.( Lateral internal sphincterotomy is an operation performed on the internal anal sphincter muscle for the treatment of chronic anal fissure. The internal anal sphincter is one of two muscles that comprise the anal sphincter which controls the passage of feces. The procedure helps by lowering the resting pressure of the internal anal sphincter, which improves blood supply to the fissure and allows faster healing).
Step 5: the V-Y advancement flap, is generally reserved for recurrent fissures or fissures that are not associated with hypertrophy and hypertonicity of the internal anal sphincter.
After dealing with Fissure for almost two months and being close friends with doctors my understand of treating fissure is eating good food, healthy food which good in protein and fiber, lots of water, stools softener and continue this for at least 8 months even if the pains disappears. Its is very important to continue the treatment even if one is symptom free, often when we feel better we tend not to eat fiber rich good and leads to re-tear and make sure one takes Stool softner( Miralax or Milk of Magnesia).
I had a very bad experience with Miralax, it made my stood rough and hard that lead to re-tear but once i figured i stopped and started MOM which helped me a lot.
My suggestions: Though LIS is a gold standard but being conservative with invasive is always wise and try all and everything you can before going in for LIS but if you are a 24/7 pain for couple of months and thats causing you to be in bed than by all means go fo LIS.
Good Luck and my prayers and best wishes for AF sufferers.
Strangeworldaf
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Re: When to go for Surgery?

Postby Sue27uk » 02 Aug 2012, 03:29

I would at least give the cream a try if you haven't. Thats just my opinion though and obviously I'm not a doctor! I nearly healed with the cream and botox option, well I did heal actually! But it healed incorrectly so I ended up having a fissurotomy operation and botox again which I am revovering from. Can you get a second opinion to see what they say? :)
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Re: When to go for Surgery?

Postby Strangeworldaf » 02 Aug 2012, 06:11

Sue.... This is my 55th day of having fissure and within this 55 days I was symptom free for 3 weeks. My mistake was I did not continue treatment after I felt better.
Here is my question to all: I feel 30% better since last week and does this mean my fissure is getting better and if I continue my progress for another 8 weeks is there a chance of getting better at least 80%.
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Re: When to go for Surgery?

Postby monkeyusa » 07 Sep 2012, 16:14

I'm a 34 y.o. male, who got a fissure through a bad bout of constipation.
I waited 6 months to have surgery...Way too long to live in pain.
During that time-span I used niphedipine ointment 3-4 times daily, drank Fibercon, and ate a vegan diet. But it didn't heal.
LIS surgery was breeze. Fissure pain was gone immediately. The incision pain lasted about 10 days, but is was nothing that a little motrin couldn't handle.
While I healed, my bowel movements hurt a little bit for about 6 weeks. I also had discharge (like butt puss) for a several months.
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