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  • My experience with Lateral Internal Sphincterotomy (LIS) for my Chronic Anal Fissure

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    Old 01-13-2010, 05:07 PM   #1
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    My experience with Lateral Internal Sphincterotomy (LIS) for my Chronic Anal Fissure

    Iím writing this because I suffered with a chronic anal fissure for a year and a half before I finally had the Lateral internal sphincterotomy surgery done. This is a long story, so for those of you who want the short version, here are the main points:

    1) Try all conservative therapies first
    2) If it doesnít heal, have the LIS done by an EXPERIENCED COLORECTAL surgeon

    So mine started with a hard stool one day. I remained constipated with hard stools, so it never got better. The pain was pretty bad, and would bleed a little with each BM. At first, my GI doctor told me to soften stools with Miralax and fiber. I tried that Ė it still didnít go away. After about 3 months of trying fiber and miralax and colace, I finally caved and saw a colorectal surgeon.

    The colorectal surgeon told me I could try nifedipine cream, but even if it worked temporarily, the fissure would likely return. He was right. Within 2 weeks, the fissure pain was gone! I was so happy. I continued therapy for 6 weeks and within 1 week of stopping, the fissure pain returned. It was so depressing!

    One thing I must note is that the pain I had from my fissure was nowhere near as bad as some people post about. Mine was maybe 5/10 and was a burning and spasm but would only last 5 minutes after each BM. So I didnít think it was severe enough to warrant having surgery.

    Well after the relapse, I saw another GI doctor who told me to try Benefiber and colace, and continue on the nifedipine cream. I did that for a total of 6 months and everytime Iíd stop applying the nifedipine cream Ė the fissure would relapse!

    I finally caved and found a GI doctor who does BOTOX. He said Iíd have a 70% chance of the botox working. I gave it a shot. The procedure itself was done under conscious sedation in a hospital (like a colonoscopy) and didnít hurt at all. Unfortunately, it didnít work either. Apparently my fissure, like most chronic fissures had fibrotic edges, which impair its ability to heal.

    I decided to see if I could just ďlive with the discomfortĒ and after 2 months decided living in fear of a BM was no way to live. Despite the risk of incontinence and infection, I decided the risk was worth it. So I found the most highly recommended colorectal surgeon and gave it a shot. He told me heíd done around 2,000 of these and NEVER had one incontinence, infection or a recurrent fissure. I thought the odds were good so I had it done.

    The surgery itself was done under conscious sedation and I didnít feel a thing! Apparently it only took 10 minutes. He did the LIS and put a stitch through his incision to minimize the bleeding. I did NOT have the fissurectomy done. That whole day my anus was numb from the local anesthesia, and only 8 hours later did I begin to feel some soreness. I did have some incontinence to flatus for the first day, mostly because I couldnít feel my sphincter.
    There was also some blood on the dressing, but no leakage or bleeding after that.

    I went home and took a nice warm bath. That night I took some ibuprofen and went to bed. The next morning and for the next several days I was very sore down there but NEVER needed to take the percocet he prescribed for me. I used 600 mg ibuprofen 3 times a day and that worked great. I also took 2 full weeks off of work. The first 5 days I had pretty severe pain at the sphincterotomy site (left side) after each BM. The first BM was bad, but not as bad as I expected Ė it stung like crazy but I immediately jumped into the warm tub and it only last 5 minutes. I was a little discouraged because this pain lasted well into 5 days, but by day 7 was much improved. I never had any bleeding or drainage.

    By day 14 I had no pain with BMs but I did feel soreness on my anus, and an itchy feeling. On day 21, at my followup, he said it was the stitch causing the itch and he removed it. Since then, Iíve had no itchiness or pain.

    Itís now day 28 Ė 4 weeks exactly and Iíve 100% better! No pain, no spasm, and no incontinence (thank God)!!! I continue to use benefiber and colace and am hoping to wean myself off of the colace soon.

    I decided to post this because I relied so heavily on everyone elseís posts when I was agonizing with the decision to have surgery. NO ONE should live with pain Ė the surgery is not that bad and if you have it done by an experience colorectal (NOT a general surgeon) surgeon you can minimize the risks. But, to be fair, the risks still exist and you must make a calculated decision.

    So, I say to those who suffer from chronic anal fissures: try the conservative ways first, and if you can live with it, thatís fine. But if you suffer every day, please consider having the LIS done Ė it works so well for so many people. Good luck and God bless you all.

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    Old 01-14-2010, 01:37 PM   #2
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    Re: My experience with Lateral Internal Sphincterotomy (LIS) for my Chronic Anal Fiss

    thank you for posting.

    i suffered for over 2 years with "superficial cuts" in my rectum caused during childbirth.

    i tried all the conservative at home methods first. did my research and got a referral to the best colon and rectal surgeon in my area.

    he too told me to try metamucil and stool softeners for a few weeks because he thought my condition was acute and that i should be able to heal myself.

    but things didn't heal, so i called him back up and he scheduled me for LIS surgery.

    i had iv sedation. i was not conscious for any of the surgery. i believe my surgery only took maybe 10 minutes. then i was in recovery for maybe 30 to 40 minutes after that and was able to go home.

    i felt sore right after the surgery. i really should have asked for some pain medication before i left the hospital because i had an hour drive home. i really regret not asking for any because my whole right home was hell. i was in a lot of pain.

    i was prescribed vicodin, but that makes me sick, so he prescribed me darvocet. which worked like a miracle. i knew ahead of time that pain killers could constipate, so i continued to drink a lot of water, take metamucil two times a day, and take a stool softener and a tablet of magnesium at night.

    my first b.m. went wonderfully. no pain what so ever.

    it has now been a little over 2 weeks since my surgery. i didn't have to take any pain medication after day 5 or so of my surgery. my b.m.s are still pain free. i have not experience any incontinence what so ever.

    i too never dealt with as severe of pain as some people on here talk about dealing with pre-surgery, but i can tell you i wish i would not have waited so long to get the surgery done.

    i am so glad i got the surgery and am looking forward to living a normal life again

    please don't be afraid of getting the surgery done. i also agree that you need to make sure you go to a colon and rectal surgeon for the surgery. my doc said he does around 200 LIS surgeries a year and has been practicing for over 35 years and he's even written an article on LIS surgery for fissures. he said back in the 90's when he wrote the article the surgery had a success rate in the 92-94 percentile and now it has a 100% success rate

    it also helps that i saw several reviews on this same doctor on a website of other people who had fissures that went to him and he healed them

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    Old 01-17-2010, 11:59 PM   #3
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    Re: My experience with Lateral Internal Sphincterotomy (LIS) for my Chronic Anal Fiss

    Thanks for posting this! I'm scheduled to get the surgery around the end of this month and I'm very nervous about it. I've been having pain for about 7 months, and I can't believe how some people lived with it for 7 or 8 yrs. I was an active person before this, and now I have to schedule my life around a bowl movement. This weekend I've been laying in bed instead of going out and that is killing me! I think I've recently developed a hemmorroid which has seemed to make things a bit uncomfortable.

    My biggest fear is the pain from the surgery afterwards, and thinking this can be something that will have to become a way of miserable life for me. So its nice to hear that there are happy endings to this story.

    Last edited by Administrator; 01-31-2010 at 09:37 PM. Reason: posted contact info - please read the posting rules

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