VY Advancement flap?

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Hi, Can anyone share there experiences good or bad of this procedure as thinking of having it done for my fissure. Been 7 months now. On Diltiazem cream 10 weeks which has helped but still uncomfortable. Unsure as to whether to manage discomfort for rest of life or just go for it,Many thanks Steve

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  • Posted

    Steve,

    What did you decide? I have read a couple of recent studies concerning the advancement flap which were very positive but it has never been mentioned to me as an option by any of the doctors I have seen.

    Anyone able to add anything?

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  • Posted

    Hi Pete, Decided on botox in end which had today! Been about 3 hrs and better procedure than expected. Seen impressive consultant in Cheltenham who has perfected his own technique of injecting botox for max benefit using a dental syringe apparantly. Adv flap was odd one as every doctor/consultant i seen advised against it as its a big op but results seemed positive. Will see how get on and decided to take a chance with LIS if this fails. Hope it works out for you. Steve
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  • Posted

    Thanks for that Steve.

    Can I ask whether you were injected under a general or any anaesthetic?

    My consultant from a reknowned London hospital is not optimistic about Botox and wants to inject in the consulting room. As some doctors appear to only inject under a general I find this a bit odd and apart from questions of accuracy I am not sure that I want someone to do it who is not in favour of it.

    My consultant never mentioned the adv flap but I see from some recently published results from Bristol that they have had very good results as a first line treatment. It is said to be a \"big\" op but I do not know what that means.

    LIS seems simple enough although the recovery times seem to be anywhere from 2 days to 2 weeks off work. I have an aversion to having my muscle cut and risking incontinence although my consultant said that he had not seen it.

    Can you give me any contact details for your consultant?

    Peter

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  • Posted

    Hi Peter

    Yesterday i decided i could not stand the misery anymore and rang to see if could see my consultant in Bristol to get something done, any cost, any operation i would of had it. He was on holiday for 6 weeks. So i rang alternate private hospital fairly local to me in Cheltenham. Secretary was ultra helpful and after listening to me said it was long shot but would contact the best colorectal consultant around to see if he could see me that day. Half hr later she called and told me to come over in couple of hrs. His name was Neil ****. He inspected and advised Botox which he did there and then without anaesthetic. Told success rate 90%. He was fairly young guy, very confident and apeared proud that he had developed technique using a Dental syring to apply botox for better placement and effect. Was a little painful but not too bad. My advice - go for botox. Today i feel sore but no worse than fissure. Re adv flap - i actually seen surgeon who wrote the report you mentioned in Bristol. He was first consultant i seen and wanted to do surgery with adv flap without even bothering with diltiazem etc. Men at very very low risk of incontinence with LIS and appears best long term surgery option. After seeing 4 consultants each with diff opinions Mr **** by far the best by all accounts. Hope this helps, Steve

    [color=green:e2d4b70ce7][size=9:e2d4b70ce7][i:e2d4b70ce7][b:e2d4b70ce7](Sorry but Patient Admin have removed a Doctor, Consultant and or Hospital name from this posting, as it is the policy of Patient UK not to publish these on this forum.) [/b:e2d4b70ce7][/i:e2d4b70ce7][/size:e2d4b70ce7][/color:e2d4b70ce7]

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  • Posted

    Hi Steve,

    More than grateful to you for that info.

    You are right Anthony **** co authored the Bristol report on the Adv flap

    and they appear to tout it as first line treatment. Maybe in future it will become so.

    I have no idea about the down times of LIS v Adv flap but my consultant said the incontinence risk was miniscule for LIS. Some studies suggest otherwise but maybe as you say not for men.

    Last point if I may. Were you given a general anaesthetic? My consultant was going to do it without. I find it strange that the same procedure can sometimes require you to be put out and sometimes be perfomed the same way as if you were getting a normal injection.

    Thanks again Steve. I've been struggling since February. The botox will be the first escalation past the first line treatments -increased water/fibre/stool softeners/GTN/diltiazem none of whihc have worked in my case.

    [color=green:d299b0f1db][size=9:d299b0f1db][i:d299b0f1db][b:d299b0f1db](Sorry but Patient Admin have removed a Doctor, Consultant and or Hospital name from this posting, as it is the policy of Patient UK not to publish these on this forum.) [/b:d299b0f1db][/i:d299b0f1db][/size:d299b0f1db][/color:d299b0f1db]

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  • Posted

    Sorry Steve. Just re read your post and see that you did tell me that it was done without anaesthetic. I wonder why some do and some don't. If it doesn't hurt anymore than a normal injection a general seems a little extreme.
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  • Posted

    Hi Peter

    Am Sorry to hear you have been struggling since February. Its certainly been the most miserable 8 months i can remember in my life. Like to think am Rational positive guy but this has challenged even the strongest will. I have a young family and have seen the affect on them, think thats why Friday was a turning point for me. Every night was trying to find Best UK consultant online whilst trying to deal with the real fear and risk of Surgery and incontinence not to mention ongoing pain. I understand your concerns about anaeasthetic as i had same issue of most consultants wanting to give g/a to administer botox. Thats why i felt Neil **** who was passionate about his technique filled me with great confidence that he felt comfortable performing without. If i was a surgeon either not confident of procedure or my skill to perform procedure i would want patient under a g/a. All consultants bar Tony **** warned against Adv flap as if it fails there is nowhere left to go. Anyway Today pain less and feels better, told will start noticing diff after 48 hrs but so far so good and feels so far like right decision. I seen him at a Cheltenham Hospital. His sec is lady called Nicky on 0*2*2 *46*26. Hope you make right decision and let me know if can help further. Steve

    [color=green:a86b6b0f5b][size=9:a86b6b0f5b][i:a86b6b0f5b][b:a86b6b0f5b](Sorry but Patient Admin have removed a Doctor, Consultant and or Hospital name from this posting, as it is the policy of Patient UK not to publish these on this forum.) [/b:a86b6b0f5b][/i:a86b6b0f5b][/size:a86b6b0f5b][/color:a86b6b0f5b]

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  • Posted

    Peter

    Meant to say that most consultants prefer using g/anaesthetic for botox adninistration as they use a standard needle which increases risk of thrombosed hemmoroid and soreness. Steve

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  • Posted

    Steve, that's all really helpful information thank you.

    I have made the appointment and hope that it is also a turning point for me.

    Botox may be not a lot better than GTN or diltiazem but at least you know that you have relaxed the muscle to enable the fissure to heal if indeed healing is to take place. I was never sure with the ointment that I had used sufficient or penetrated deeply enough for it to work although I certainly had the usual headaches with GTN.

    When you say there is nowhere else to go after adv flap do you mean that you could not thereafter have LIS? LIS itself is of course irreversible but presumably does not mean that you cannot have the adv flap.

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  • Posted

    Hi Peter

    Really pleased you have made the decision to go for botox before thinking about surgery option (which hopefully you will not now req). I have gone through same thoughts about Diltiazem which i had been on 13 weeks with some improvement but not complete.

    The last 8 months i have made effort possibly like yourself to learn as much about subject as possible as the stakes seem high and the decisions important. I have a busy work and family life so this as not always been easy but have concluded that botox if applied by someone who knows what they are doing can be statistically as effective as surgery without the obv risks and hassles that goes with it. Ultimately the aim appears the same for both which is to normalize resting pressure, increase blood blow & decrease spasm. If this doesnt work then the choice of surgery it appears is down to individual cases but i didnt seem to fit into the categorys that most benefit eg I am not gay, female or have low pressure sphinct. I hope it works out for you Peter!

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  • Posted

    Steve, I had the botox injection yesterday expertly administered by Mr ****. It had a wince factor but bearable.

    No benefit yet. I hope something postive comes out of it all. Is there a paucity of people who have had botox or is there just a lack of people posting here?

    You are right that Mr **** takes the view that adv flap comes last in line

    of treatments as if it doesn't work you then have two problems to deal with. On the other hand the studies seem to show quite a quite sucessful

    outcome without the incontinence risk of the muscle being cut. Tough one.

    The next option may be a repeat botox injection and tidying up of the fissure albeit under a general.

    How are you progressing? I think that you are a week or so ahead of me.

    [color=green:63ef3510d9][size=9:63ef3510d9][i:63ef3510d9][b:63ef3510d9](Sorry but Patient Admin have removed a Doctor, Consultant and or Hospital name from this posting, as it is the policy of Patient UK not to publish these on this forum.) [/b:63ef3510d9][/i:63ef3510d9][/size:63ef3510d9][/color:63ef3510d9]

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  • Posted

    Hi Peter

    Good to hear you took the Botox plunge. This website deleted the name of consultant you used but am assuming it was my chap from Cheltenham.

    You are right there is a certain wince factor but nothing it seems that justifies a g/a.

    I had tried coming off the Diltiazem cream shortly after but within a day symptoms and pain was back . I now have bad pain around injection site of one of the jabs so diff to sit. Hoping not infection or thrombosed hemm.

    Would love to report lots of positives but guess early days still. I dont regret having it although have to say this injection pain is pretty bad.

    I know you have seen diff consultants, how did you feel about him? Problem i found is that it was surprisingly difficult to find a surgeon doing LIS. Guess in age of litigation fissurectomy or even adv flap is becoming the norm. Steve

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  • Posted

    Yes Steve, same guy. He seemed entirely competent and took his time explaining the different procedures but perhaps that is the norm when you see a doctor privately.

    Unfortunately for all that if the 48 hour period is critical things are not looking good. To be honest I have had no improvement whatsoever which is really disappointing. Even tougher for you if you have to deal with injection site problems.

    I would love to be proved wrong but it looks like we are heading for

    somethimg more invasive: either repeat botox with fissurectomy- I have no idea what the chances of success are -or LIS/Adv flap. I do not have insurance and for the LIS/Adv flap will have to go back into the NHS.

    I do not know if you have insurance cover but presumably the consultant we saw will do LIS? As I said his take was that if the adv flap did not work you ended up with two problems and therefore LIS came first. My NHS cosultant in London wanted to go straight for LIS without botox so some must be doing it.

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  • Posted

    Peter, I wouldnt give up on the botox just yet. It doesnt work straight away and most consultants predict no improvement first week, slight improvement 2nd week with max improvement 3 to 4 weeks. So hopefully your 2 days so far will lead into great things. I think i have reached the stage that if surgery has to happen then so be it. If it reaches that stage then at least i have tried everything. Yes am in fortunate position to go private but LIS is a lot cheaper than adv flap which maybe within what you can pay. Tony Dixon notified adv flap would cost £7500.00 so maybe no wonder why he chooses to do this as first line procedure even before trying Nitro/Dilt. Steve
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  • Posted

    Just re read what you mentioned. Who mentioned about the 48hr being critical? Steve
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