At my follow-up appointment today with Dr. Varma at UCSF, who is ranked by her peers as one of the top colorectal surgeons in nation, I asked how much of my rectal cuff was left in tact.
Her answer was none. Or more realistically, as little as possible, which was less than one centimeter. The reason? To avoid UC of the cuff, a.k.a. "cuffitis." She pointed on a diagram to where the cut had taken place, and it was pretty much right at my anus. She told me that
leaving the rectal cuff in tact is almost never done any more, which negates the need for the "scraping" or "musectomy" that people on various forums keep asking about
.
I referenced a study from 1992 (twenty years ago) that discusses the necessity of the rectal cuff to continence. She said that strategies have come a long way since then, and in recent years in particular the newer stapling techniques have made a big improvement in the way they go about
constructing and attaching J-pouches, and that is likely what has made the difference.
Either way, I can't believe that she would be so revered/respected if she was making a practice of leaving her patients incontinent, so I trust this surgeon, and she says that the rectal cuff is no longer necessary for continence. I will let you all know how continent I am after takedown.
