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2nd Surgeries - Success Rates???

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Crohn's Disease
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Posted 1/13/2010 2:27 PM (GMT 0)
Hi everybody,

I had my 1st surgery in 1999 - to my terminal ileum with ileocecal valve removed etc. Now on Questran only and Lomotil for really bad days. I recently had a capsule endoscopy in which narrowing showed up. A balloon dilatation was done but to no avail. My symptoms have become increasingly worse in the last 2 months. Going from bloating with occasional D & C to constant D & constant bloating and more pain before BMs. As soon as i eat i have to dash to the toilet within minutes. And it makes no difference what i'm eating. I am waiting to hear back from the hospital as they want me to try Humira. I really feel that this is not going to help as i can almost feel the narrowing/stricture getting worse as every day goes by. I also get extremely tired whilst eating a meal, which is how i used to feel before my 1st surgery. I could literally fall off the chair with weakness as soon as i eat a few mouthfulls and my intestines start going bonkers! I am losing weight also which i have not done in years.

Although i am terrified of another surgery, i just feel that no amount of strong medication is going to help when there is such a narrowing there. So i was just curious as to the success rates for 2nd surgeries - especially those that take place at the anastamosis site from the previous surgery? Or has anybody found meds successful with a stricture? All info will be greatly welcome.
Posted 1/13/2010 2:34 PM (GMT 0)
I had to have a second resection only 3 years after my first because I was told I no longer needed maintainence meds. So first and foremost, be sure you take maintainence meds at all times after your surgery. I will tell you that I am in remission again, but it took me a little while to adjust to the difference the surgery caused. I have to watch my diet a lot closer now, but am doing well other than my joint problems. Actually those are more of a problem for me than the Crohns now. But I am hopeful that I will maintain this remission for a while. I also live on a low residue diet all the time now, and that works well for me. Good luck!
Posted 1/14/2010 1:12 AM (GMT 0)
My first two resections were end-to-end anastomoses. They narrowed and caused total obstructions eventually.
The third resection was a side-by-side asastomosis and it has held since 1995. I hope you avoid it altogether.
Posted 1/15/2010 12:29 PM (GMT 0)
Thanks for the responses guys.

Nanners: you're right about the maintenance meds, that's why i'm in this situation 10 years later as my last GI just put me on Questran after my resection and never mentioned another word about maintenance meds. And i was foolish enough to trust him. Unfortunately i knew nothing about this disease at the time and never questioned a thing. Luckily i have changed GI since and if i need a second surgery i will be sure to insist on maintenance meds.

Hldwodrgs: i don't quite understand the difference between the end-to-end & side-by-side resections. Could you explain? I would hope to get a long recovery if i go through another surgery although i am very aware that anything can happen and things can go wrong also.

I would also like to think about having children in the next few years and i'm very confused as to whether things get worse after childbirth/ childbearing? V.confused & fed up!

Lila
Posted 1/15/2010 7:55 PM (GMT 0)
End to end the anastomosis site is only as wide as your intestine. Side to side allows for a wider intestine at the anastomososis.

Think of cutting a straw in half and then rejoining it end to end.

Then think of cutting a straw in half, and slitting the ends down the side a short distance, and "stitching" the opened sides together. Now you have a wider straw where the sides were put together.
Posted 1/15/2010 8:02 PM (GMT 0)
I think the surgery sounds like a really good option for you. It sounds like you got 10 good years out of the first one, and a repeat could put you in great shape to try for pregnancy. Some people flare after childbirth and others don't, there's just no way of predicting it. But if it happens, you can deal with it then.
Posted 1/15/2010 8:20 PM (GMT 0)
after my 1st surgery I went to a different surgeon, hospital etc. for the other surgeries as i would say the 1st was not 100% whereas I was more condient with the others. So I guess Im saying if the 1st was unsatisfactory perhaps change the surgeon and hospital. You want to have it done if its leaking before it affects the other areas of tissue. As far as meds..I think we bounced the stricture issue around ,and havnt reached any conclusion as to what med is best. I suppose I went as far as questioning if prednisone was actually contributing to strictures.
Posted 1/18/2010 11:10 AM (GMT 0)
ChronieToo: thanks for the explanation on end to end & side to side resections.

Writer: i guess you're right, it'd be better to get into the best shape possible before pregnancy and just hope that there are no flares etc afterwards.

medchrt1: i have changed hospital/ GI/ Surgeon and feel alot more confident about any procedures i may be facing. Just wondering what you mean when you refer to leaking and affecting other areas of tissue??
Posted 1/18/2010 10:35 PM (GMT 0)
Here's some further clarification about one type of anastomosis. The side to side method is also called the "functional end to end" anastomosis, not to be confused with a regular "end to end". The FUNCTIONAL end to end allows for a wider opening, and therefore, hopefully a longer time in between surgeries. Here's a link to a diagram of this anastomosis type, and also an article about a possible decline in recurrence rate with this method.

I had a small bowel resection (with the IC valve removed) in July 2009 and had the functional end to end done.

http://autosuture.com/autosuture/pageBuilder.aspx?contentid=121867&webPageid=0&topicid=121841&breadcrumbs=0:122497,31271:0#pageContent


http://www.ncbi.nlm.nih.gov/pubmed/14571753
Posted 1/18/2010 11:18 PM (GMT 0)
LiLa, my first resection was the same as yours, they removed 12" in total including the ileo-cecal valve & appendix. I continued
with maintenance therapy, but had to have a further 14" removed about 18 months later. Since then no further surgeries, that was
6 years ago. For awhile I was on remicade (developed allergy), then Humira (developed Lupus), so at present I'm not allowed any
drugs other than short courses of steroids. I have kept pretty well, so I think the second surgery was a good thing. I'm hoping it
stays that way as surgery is my only treatment from now on. I do still have constant diarrhea 6 to 8 times a day, and I feel I'm
still struggling with the disease, but I think that's the nature of the beast, but at least I haven't obstructed, so in my world that's
doing pretty well.

Good luck with what ever decision you make.
Posted 1/19/2010 1:26 AM (GMT 0)
Wow dunny2 ~ so sorry that you had to have surgery again so soon after your first one. That's also too bad about not being able to stay on maintenance meds. Glad that you have steroids to fall back on when needed. That's great about you going 6 years so far without another surgery!!

If you don't mind me asking, what were your Lupus symptoms, and how long were you on Humira before having to stop it?
Posted 1/19/2010 3:29 AM (GMT 0)
My symptoms were vague at first, dull aching in the legs & wrists, fatigue & a rash on the backs of my hands. As a little
time went by, the aches made way to pains that made it difficult to walk, and generally feeling unwell. The doc did several
blood tests that came back positive for lupus. I had been on humira about 4 months.

I hope this helps.
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