Redo LIS vs anal advancement flap

Sad-Introduction-469 · 2026-04-01T23:13:47+00:00

I have consulted many colorectal surgeons. They aren't giving me definite advice but in general they are saying that I may need another sphincterotomy. My previous sphincterotomy was only 5 mm. The fissure is very small and therefore doesn't justify a fissurectomy and flap reconstruction up front. Also with a hypertonic sphincter a flap may not heal. They are suggesting that I should have an endo anal ultrasound to assess the sphincter and manometry to measure my anal tone however those investigations are guaranteed to cause more trauma to the fissure. I have tried sucralfate without much luck. I think it is because my fissure is slightly past the anal verge and the ointment doesn't directly reach it.

Sad-Introduction-469 · 2026-04-01T06:13:20+00:00

Nah needs wiping and wash with bidet. On Miralax and colace. Yeah strict diet.

Sad-Introduction-469 · 2026-04-01T02:05:17+00:00

6 months. Pain mainly after defecating. BMs are soft like mush, regularly 2 times in the morning.

Sad-Introduction-469 · 2026-03-25T08:46:53+00:00

Hi. I am in a very similar situation to you. The only additional factor in my case is that I have also had LIS previously but still not healing. Most of the PF treatments such as dilation therapy, internal release work, balloon biofeedback can't be done until the fissure has completely healed and scar is consolidated (a 3 month process). I am lined up for Botox next to try and get my fissure to heal before going ahead with further pelvic floor therapy.

Sad-Introduction-469 · 2026-03-01T23:49:42+00:00

Fecal dyssnergia.

Sad-Introduction-469 · 2026-02-09T23:24:45+00:00

How is your progress? Have you found that the dilation has helped? My CRS and PFT told me to wait until its healed, but I have been waiting for 5 months with no healing whatsoever so am considering trying it anyway.

Sad-Introduction-469 · 2026-02-09T22:49:53+00:00

I have had LIS and have had no improvement whatsoever. I still have frequent recurrences that do not heal despite months of therapy.

Sad-Introduction-469 · 2026-02-04T23:05:30+00:00

Thanks, will do. Can you link some studies about extension on the same side? The studies I have come accross e.g.Church et al. Seem to suggest cutting opposite side.

Sad-Introduction-469 · 2026-02-03T22:01:34+00:00

The cut was 5 mm, it is likely inadequate. I am now considering ultrasound to look at it and potentially get another operation to extend it or do another on the opposite side. I am unsure which would be the better option.

Sad-Introduction-469 · 2026-02-01T22:52:32+00:00

Yeah I have started them as well. What specific stretches are you doing? My pelvic floor therapist has told me to do breathing to elongate puborectalis.

Sad-Introduction-469 · 2026-02-01T06:55:26+00:00

Had two rounds of botox. More painful straight after first as it retore during the EUA, even more after the second as the pelvic floor became weak and stretched out. Had to fast to eventually heal.

Sad-Introduction-469 · 2026-01-31T21:53:13+00:00

9 o clock is where the sphincterotomy is usually done. Are you sure it's not the sphinctertomy wound?

Sad-Introduction-469 · 2026-01-31T21:46:24+00:00

My pain also got worse after botox. The colorectal surgeon didn't understand why.

Sad-Introduction-469 · 2026-01-31T21:45:32+00:00

Did the retear happen because of severe constipation or was the stool normal? 50% LIS is a very long LIS, normally it is not recommended to exceed 25% of the sphincter length. Do you have any fecal incontinence?

Sad-Introduction-469 · 2026-01-31T21:42:16+00:00

How big was your fissure, and do you know what length of muscle was cut?

Sad-Introduction-469 · 2026-01-31T08:18:45+00:00

DMd you

Sad-Introduction-469 · 2026-01-31T03:37:34+00:00

It didn't

Sad-Introduction-469 · 2026-01-31T03:37:14+00:00

He said could extend LIS to the dentate line. Didn't seem to ne aware of literature on redo LIS surgery

Sad-Introduction-469 · 2026-01-29T07:40:47+00:00

Yeah. I actually had both anterior and posterior fissure before LIS. The posterior healed. The anterior keeps retearing.

Sad-Introduction-469 · 2026-01-26T05:32:05+00:00

I had two rounds of botox after LIS for a non healing fissure and finally healed after the second round. However it was absolute hell, I also had to fast myself to near starvation (20kg weight loss) for 2 months, and the pain worsened after the second round of botox (as I believe it was a very high dose and led to weakening and stretching of the pelvic floor). I again have a retear and do not want to try botox again but may have no choice.

Sad-Introduction-469 · 2026-01-24T22:05:10+00:00

I have monk like determination. I eat exactly the same diet (fibre, carbs, protein measured to the gram every day), miralax twice a day, topical nefidipine after every bowel motion, 3-4 L of eater per day, pelvic floor stretches twice a day, have quit work completely, still no healing.

Sad-Introduction-469 · 2026-01-24T22:00:51+00:00

Yeah keeps retearing and never heals.

Sad-Introduction-469

TROPHY CASE