VY Advancement flap?

Peter, After suffering even more pain last few days the decision feels easy. Having LIS done this Friday morning. After many consultant visits and doubts enough is enough. Doing the `Nick` version of LIS along with tag removal. Will let you know how it goes. Steve

Steve, I hope this gets to you before the op tomorrow.

It sounds like the best step to take given the ongoing pain.

Even I would have to concede that with the fissure apparently healed you would have to go for \"LIS lite\" if botox did not work.

Anyway the very best tomorrow. I will be thinking of you and hoping that your long painful journey will at last come to an end.

Let me know the outcome as soon as you are up to it. Good luck.

Peter, Thanks for your support. Was holding on a few days before posting this as was hoping of sharing good news. Had Tailored sphincterotomy last friday at Cheltenham. He also removed iritated internal skin tag which i suspect was the problem really. He said he decided to continue with TS as i had had some success with botox and stood more chance of not returning. Wished he hadnt to be honest. Op was quick and woke up with no pain, thought initially made right decision. Anaesthetic wore off and very painful. Was home 2 hrs after op which included a not to pleasant 45 min car journey home. Pain really bad that night although to be fair didnt take painkillers as make stomach bad so anyone else prob fine. Week later still in pain. Seen Mr B wed and gave me antibiotics as looks infected. BM in mornings v. painful same pain as in early days of fissure prev. Good news so far is no incon although suspect some leakage which Mr B says normal first week. Before op Mr B did go through discussion about Tailored sphincterotomy which did sound lot better than usual LIS - said the risk of incon was `virtually nil`and he took very conservative approach cutting just 3mm of muscle. In his disclaimer said 2% risk but unsure if this is min can state. So summary is if it works TS sounds good bet as success rate unrivalled. Reality for me so far not great but havent thrown in towel yet. Hows things with you, any change? dates for fissurectomy? Steve

That sounds a bit disappointing Steve but my thinking is that you can't expect the aftermath of that type of surgery to be pain free however tailored it may be and my gut feeling is that things will settle down and improve. Be patient and fingers crossed.

My own situation is a bit uncertain. On the NHS I don't think that I have seen the same doctor twice, so going over the history is tedious and the approach differs from the conservative wait and see to the radical anything other than full blown LIS is a waste of time.

The doctor who was in favour of the botox/fissurectomy got moved and the op was cancelled. The latest one I saw said that with the fissurectomy you had to take into account the disruption caused to any tissue that had healed and it might be worth seeing if things did not improve now that I had had some relief.

On balance I can live with a maybe not severely painful but uncomfortable condition, artifically managed for a while longer but I do feel that at some point some intervention is going to be necessary.

Let me know your progress. You are due for a breakthrough soon.

Peter, latest update after op. Feeling as low as i have felt in any time in my life so will keep brief. 3 weeks on still same pain so op probably not helped. Ongoing infection that cannot shift down there adding to issue. may need further sgy if infec does not heal as seeping and pussy. Sense of hopelessness has set in. Hope you fairing better. Steve

Steve, this must really be tough to take. I am putting up with daily managed discomfort/pain from a condition whcih apparently will not heal but nothing compared to you.

None of this makes sense. The sphincter muscle must surely now be relaxed and the fissure itself I thought had all but healed.

I cannot imagine that you want to try a more radical sphincterotomy and

I would want the definitive cause of my pain identified before I had any more surgery.

I only hope that at least some of the pain results from what is clearly major surgery and will therefore eventually pass. The infection they must surely be be able to clear up.

Steve, I can only send you my very best wishes, thank you for the support you have given me and pray that you finally make a breakthrough. You deserve it.

P.S I am going to post a brief reply on the new thread which has appeared. Against my better judgment as on every previous occasion there has been no response or acknowledgment. Or am I wrong to expect such?

Hi Peter, forgive my last post. Sounded really negative on reading back and feel like don't want you to have any unnecessary fears re any surgical path you may decide possibly later. When I was talking about further sgy i was talking about if infection turned into abcess then sgy to repair accompanying fistula would be ness. No way would go through any more fissure sgy as bad decisions go this is prob up there as pain is same as before just with infection to deal with. My prob is now likely to be a nerve sensitivity issue brought on by the initial slow healing fissure. That is only rational explanation.

Thanks for your kind words re my support to you but I am equally grateful. I never thought I could have so much communication with a stranger about something so personal but I value all your views and knowing there is at least one person who comes close to understanding is helpful. To be fair to mr b he has been great in terms of post care contact and have his mobile to call anytime if need be which is a rarity with some consultants with delusions of grandeur. Hope you managed to enjoy Xmas.

Steve

Steve, not at all. I think your post was fair enough in the circumstances.

You never know we may meet up waiting to see Mr B.

When they did the op did they cut through the existing fissure to get to the sphincter muscle or is that left alone and some other path taken?

I am just trying to work out what is going on.

Had the initial fissure healed but the pain is a residual nerve issue which has nothing to do with the surgery? This is difficult but what test proved/suggested that the pain was caused by a spasm of the sphincter muscle leading to the LIS?

I agree your comments re consultants. I am handling a number of conditions requiring possible ops at the moment and as I think I mentioned I cancelled knee surgery for next week because the attitude of the consultant was less than impressive. Overall having seen a number of doctors this year my general view is not positive.

Hi Peter, happy new year to you. The fact that am writing this post at 5 am may tell you things no better. In answer to your question re tests for spasming before lis I went on recommendation by mr b and one other consultant that this was only poss explanation of ongoing pain. A third gastro consultant stated poss pudendal nerve as reason but I felt it unlikely at time as meant would be coincidence of two conditions at same time at same place. Obviously now feels like wrong call I made. He made a separate incision to original fissure site which nearly 6 weeks on still has not healed. Poss due to constipation from all the antibiotics have had to take recently meaning too much straining. So now dealing with new fissure, nerve pain? and feeling bloody miserable. Anyhow some positivity is needed so am trying to see this as a temporary hiccup. Was shame to hear about your cancelled knee op due to how you felt about consultant, what condition is causing your biggest pain right now? Steve

Steve, sorry for the delay but I have not been able to access this website

on the couple of occasions I previously tried.

Hopefully you are making some improvement after all this time. I guess

the new wound caused by the cutting is causing the pain. If that is not yet healed then presumably it is because of the infection and not any spasm which should no longer be a factor.

It is not clear though why you should have pain all the time- if that is what is happening-now that the spasm has been addressed. The argument againt the flap always seemed to be the fact that continuing pain was evidence of spasm which is why now that my pain is mainly limited to passing that Mr B considers the flap an option.

I am sure that you are right about the antibiotics. Are you taking stool softeners/oil etc? I could not live without that regime.

I can work around the knee and hernia. Obviously the hernia long term needs attention but so long as it stays within the realm of discomfort I am avoiding hopitals if I can.

As predicted no response to the reply I made to the new thread. I will know better next time.

Steve, I know how intrusive and debilitating this condition can be and it is daunting to have to live with it with no improvement in sight. I just have to believe though that you will post some good news soon. I really wish that you didn't have to put up with it but I am sure that one day there will be a resolution.

Hi Peter, hope you are well and thanks for your supportive words. Yes it certainly is tough and I too one day hope to post good news on here. Mr b is at a loss. Pain is worsening. Seen new nerve consultant who thinks am unlucky as he feels have pudendal neuralgia which happened at the same place at the same time as fissure. Almost too hard to believe ain't it. It's a painful condition with poor prognosis. Hope to god he is wrong but few alternatives for reason for continued pain. Quality of life as close to zero as a man can get. Origin fissure also now reopened as had bout of constipation following a.biotics. Started amitryptiline to manage pain. I am a rational thinking man who has never suffered a day of depression but right now feel I need to be Taken from my misery. Sorry these posts one way at moment Peter but I do sincerely hope you remain if not pain free, able to manage the pain remaining from both fissure,knee and hern you do get. Steve

Steve, as you are now being pointed in the direction of pudendal nerve damage I can imagine another long round of consultants with differing views, researching conflicting medical opinions and seemingly never seeing the end of the problem.

It may be the definitive diagnosis in your case but I do hate this type of diagnosis by exclusion. It does sound like the type of thing they come up with the can think of nothing else. If it is right presumably a nerve block- at least temporarily -will provide relief and be evidence in support or can they do other tests?

Severe chronic pain is debilitating Steve. I know that it is a testing and trying time. I also know that the fact that these things are not life threatening is small comfort but for the moment you have to hold on to that, stay positive and meet this with a show of character I know you possess. I know that you can do it and that one day you will find a way to control this. Good luck mate and keep me informed.