Advancement Flap Surgery - My experience

Hi all

I thought I post my experience of advancement flap surgery as I could only find really scary stories on the web before my surgery. Hopefully I will have a positive experience overall and this will help someone who is going to have a similar procedure.

I went to hospital yesterday for this procedure and being in the UK it was on the NHS. Now the NHS is great institution but sometimes it does make you feel a bit like a piece of meat on a conveyor belt thru the hospital.

I hadn't met my surgeon before yesterday and he gave me precisely 2 mins of his time before the surgery and I didn't get to talk to him afterwards and there is no follow up appointment! He met me on the ward and described the procedure to me in front of about 10 other people who were in the room. He asked me to sit whilst he stood over me and just said that's what I'm going to do sign the consent form here! I know surgeons aren't necessarily judged on their communication skills but wow! Anyway the nurses were excellent.

When I came around after the surgery I must have had local anaesethic because I felt no pain in my bum at all. In fact the needle in the back of my hand was the most painful thing at this stage.

So they sent me home (eventually about 3-4 hours after I woke up) with a supply of ibuprofen and paracetemol. Plus some really attractive mesh underwear and linen pad thingys (a bit like muslin squares). There is quite a bit of bleeding (hence the pads) and I can feel (I don't want to look!) stitches which start about 1-2 inches from my anus and disappear up my bum!

So far the pain is manageble and not as bad a fissure when it's really going for it.

Now the real tester is gonna be a BM. I thought I was going to have one last night but it turned out to be just water (I assume they flushed out my bowel in some way). Anyway that didn't actually hurt at all but the anticipation was agony!

I am sure I'll have a BM tomorrow so I'll post again about any changes in pain etc then.

OH boy - that is just great to hear !!!!!

You did great so far , I am so happy to hear that !!!!!! Couple of our members had that procedure and also had great result !!!!! KTW

Yes - your guts are empty at this point so it will take a day or 2 for anything to come down ; ). Just keep it soft and nice and you will have nothing to worry about !!!!! Even that water could make you feel the burn - you remember fissure days ??? So , it is a great sign that things are mending pretty well

Thanks for your encouraging words Fissulyna. I really wish I had found this site earlier because it is a great comfort to 'talk' other people in similar situations.

I have been nervous of surgery and put it off for so long. In fact I nearly talked myself out of again as my fissure had 'healed' itself. This would only have been temporary of course.

No regrets at the moment but I am still cautious and we'll wait and see how it goes long term. Fingers (and everything else) crossed.

Elf, that's fantastic that your doing so well, it's great to see positive feedback after invasive treatment, please keep us posted.

Wishing you a speedy recovery.

Yes : ))) - you still will need time to heal and some soreness will be there for short time - but the biggest hurdle is out of the way and you can concentrate now on real and forever healing !!!!

Keeping fingers crossed for you

Day 3 and the dreaded BM (in fact 2)

I had two BMs today (a small one and normal sized one if you are interested!). Neither hurt particularly which is big relief. It did sting a bit afterwards for a minute or two but it was nowhere near as painful as a fissure.

In terms of the general pain that I have experienced so far, it is quite superficial really. Having said that I am taking paracetemol and ibuprofen regularly. The pain isn't like fissure pain. I found fissure pain very 'deep' the pain seem to radiate from inside my body. The post op pain is basically soreness and feels very much like surface pain, like a cut in your skin (which of course it is!).

The bleeding had slowed down quite a bit but going to toilet has started it up again to a small extent ( the nurse said this could happen for up to 2-3 weeks). There was no blood on the toliet paper though and it isn't like blood from a fissure (i.e. bright red). I now have a brownish bloody discharge (the sort you get from weeping wounds) again the nurse warned me this would be the case.

The doctor has told me to wash myself in the shower after BMs and at least twice a day. He recommended using aqueous cream and then drying my bum with a hairdryer (the first casualty of a fissure really is your dignity!)

MAYOR CONGRATS

This just fantastic news , oh my , you have no idea how happy I am to read that you "survived" TWO BMs with no "casualties" whatsoever !!!!

From this day on - you will be having steady and great healing path !!!!

May you heal with ULTRASONIC fastness : ))) and stay pain-free forever

OK. Quick update just over a week from surgery and everything seems to be going fine. Pain is reducing (although I am taking quite a lot of painkillers) and blood/discharge also getting less but it is still there.

I plucked up courage today to get a mirror and have a look at the area. I now wish I didn't! It looks a bit like Frankensteins butt! I have a V shaped bit of skin with sutures all around it about the size of 2 postage stamps. Worryingly there is a small hole at the end of the flap close to the outside (i.e. not a the business end). This is the bit that I assume is weeping/bleeding and it also hurts to the touch. Should I be worried by a hole? Or will this heal up by itself?

Also sorry in advance for this bit and don't read on if you a bit squeamish!

Since the bleeding has slowed down when I change my dressing (twice a day) it is quite smelly. I have no increase in pain or anything so I assume this isn't a sign of infection but is this normal? Any advice from post-op people would be appreciated. Thanks

You should see your CRS so he can check the tiny hole and the discharge.

My best guess would be that he actually left tiny hole unsutured so that wound can drain and prevent infection !

But - whenever in doubt, it is always better to check with a doctor !!!!

Best of luck and thanks for posting : ))) !!!!! We do not have many people here having done a "flap" and it is extremely useful for all people who might have it done in the future

PS: There is absolutely nothing gross about describing any of your symptoms here on this forum - nothing that we already did not read or experienced ourselves , so please feel free to write about any concern you might have !!!!

Well after worrying about it/ignoring it for 2 days I went to A&E to have the surgical wound checked out. The hole has got a bit bigger and this was playing on my mind to say the least.

Anyway the A&E doctor had a look and agreed that the sutures hadn't worked on this part of the wound. However he thinks it will heal just fine (by secondary intention technical term which I googled!). He did say that the inside of the wound looks a bit macerated so he is going to treat it as infected. So he gave me some anti-biotics and told me to see my GP in couple of days to make sure everything is going as planned.

I'm really relieved TBH as he said it is healing ok. My main concern was the flap breaking away.

OK quick update.

I need to see the practice nurse every day at the moment to apply a special anti-bacterial dressing. None of the medical professionals seem to think the wound is actually infected and this is to be on the safe side really.

The wound is still discharging quite a bit (i guess a couple of tablespoons of liquid per day). It isn't particularly painful but I am bored of it not healing properly. Still it is only 12 days since the surgery hopefully it will heal soon.

The actual flap of skin sown over the fissure seems to be healing fine. I am having problems with the site that the doctor cut the skin flap from.

I am recording this because hopefully it will help someone else who is going through similar surgery one day.

One other thing is that as part if the op the doctor also gave me botox. This means that when I need to go to the toilet it is very urgent! I have about 10 secs to get to the toilet before things become super urgent! No accidents yet but it feels like there could be! Has anyone else experienced similar with botox?

Thanks Elfkin for posting !!!!

I had a very "nice" chunk of anus cut off together with my skin tag so yes - that little "hole" which I called "black hole" LMAO did need more time to close than anything else in that area.

Wishing you super-fast continuation of the healing

I think it needed about 6 weeks in my case - but was definitely most likely much smaller hole than yours !!!!

Oh well.

The point of my posting was that I hoped to provide some positive feedback about this procedure but unfortunately I now don't think that's going to be possible.

About 5 days ago my sphincter suddenly tightened up. I don't know if the botox wore off but that doesn't seem likely as it was only a month ago that I had it.

Anyway doing a BM become a real struggle and it also hurt. Not agony but it was painful for the first time since surgery. Today it hurt a bit more and I had the dreaded blood on my toilet paper The pain level is fairly low to be honest its mainly my anxiety thats the problem!

I feel worse off than when I had the operation as it feels much tighter now (and the botox hasn't even fully worn off). Plus I guess my fissure is back or at least a new one.

As the NHS is a bit of nightmare I haven't been able to see a CRS yet (despite trying to get to see one via A&E). I've seen my GP and she prescribed Diltiazem and told me to up my Movicol dosage.

I've used GTN (rectogesic) for years but without sucess so I guess Diltiazem is worth a try. How has everyone else got on with it?

I am so terribly sorry to hear that Elfkin !!!!

You know, anybody here who ever had a flap done (as far as I know) also had a LIS performed at the same time and they had permanent good results . I really do not understand why your CRS relied on a temporary fix with a Botox , especially after so many years of suffering with chronic fissure . My only guess is that he is not comfortable doing LIS and maybe had some bed results (read cutting too much) and is now scared to do it . So, my advice would be to go private if you can and find a top notch CRS who has great success rate with the LIS.

If you are absolutely terrified of a LIS , than use creams or get another Botox ASAP !!!! Maybe he did not give enough of toxin or did not hit the right muscle with a needle . You kow - tha whole ting with a Botox is still in "investigative phase" - they still do not have one universal protocol !!!!!

Regarding creams - I liked Nifedipine cream the most . It did not gave me headaches nor itching and burning. I recently tried Dilit. as a preemptive measure since I had some minor butt irritation and it caused such burning sensation that I used it only ONCE !!!

But, we are all different

Wishing you the best of luck with it all

OK quick update.

I have increased my Movicol intake to 1 sachet in the morning and 1 at night. Also following a tip from Cherylk I also take 2 teaspoons if Benefiber at about 6pm.

(Figures crossed) This has really helped no straining or stretching as everything is so soft. Whilst the fissure/ripped stitches or whatever hasn't gone yet I think it is improving. I have had no blood on toilet paper for instance and only fairly minor soreness/burning in the bum area e.g. not serious fissure like pain.

I am also using Rectogesic night and day. Not sure this is necessary but keeping it up for a week just in case.

I am a bit frustrated as I hoped the operation would 'cure' me but hopefully I can limit the damage and I will still heal.