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3 step j pouch

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Posted 11/12/2015 2:06 AM (GMT 0)
Sorry for the questions, a lot of suspense with surgery a couple weeks away. I know I should know this, but what is the difference between 2 steps and 3 steps. I will be having 3 steps the surgeon said but I had a hard time understand what the additional step does or what it's for. Are their better outcomes with 3 steps? Do I still have the bag after the second step? Any information on this is greatly appreciated, thank you.
Posted 11/12/2015 3:05 AM (GMT 0)
Three step jpouch:
1) Colectomy and end ileostomy
2) Jpouch creation and loop ileostomy
3) Takedown

Two step:
1) Colectomy, jpouch creation and loop ileostomy
2) Takedown

So if you are having a three step jpouch, you will have an ileostomy and bag after both the first and second surgeries.

You probably should write down a list of questions for your surgeon and WOCN (wound, ostomy and continence nurse) to go over during your pre-op appointments. It is a LOT of information to absorb and impossible to remember it all while managing everything from an emotional standpoint. Asking questions, writing down the responses and arming yourself with as much information as possible will help you better understand the various steps, what to expect, what recovery will be like, how to manage the ileostomies, how to best maintain your health in between surgeries, etc.

Going through this process without a clear understanding will only make it that much more difficult. Good luck.
Posted 11/12/2015 10:40 AM (GMT 0)
The outcome is the same with each way. One isn't better than the other. (With the exception of the fact that you'll be done with it all sooner with a 2 step....one less surgery.) Sometimes it's surgeons preference (the way they were trained) on how they do it. Sometimes it depends on the health of the patient and whether or not they were on high doses of steroids prior to surgery. My surgeon felt I was a good candidate for a two step so that's what we did. He also performed 3 step procedures. There are people who have had this done all in one step. It's not done very often and usually for people who have FAP or cancer and not UC.
Posted 11/12/2015 4:50 PM (GMT 0)
I am having 3 step. I've had the first 2 steps and I still have a bag. atwoodt explained the steps well. I am having 3 step because of my condition and my surgeons preference. I had UC for a long time and the flare up was active for a long period of time. I guess this made me a less likely candidate for a 2 step. I do believe if I had gone to another surgeon, i could have probably gotten a 2 step, but I wanted to go to the surgeon I liked, who had the most experience, so I decided I would do what he felt was safest. I was also carrying some extra weight which apparently can make it harder to perform 2 step. My surgeon said he would do 2 step if possible. it sounded like my anatomy wasn't the best for it unfortunately. I would have loved to get it over with in 8 weeks but the 3 step has gone a lot faster than I expected. I don't really care at this point, i just want a good result. I don't think # of steps has anything to do with result. I think it's mostly surgeon's skill level and your anatomy that leads to a good result.
Posted 11/15/2015 6:45 PM (GMT 0)
My daughter had 2 step....colectomy & JPouch formation and temp ostomy 9/30/11 and then had take down 3 months later 12/28/12.

Good luck to you!
Posted 11/28/2015 6:49 PM (GMT 0)
I had 3 steps. Both of the surgeons I interviewed said it was best. My cousin had 2 steps because he was so sick that his rectum couldn't stay in. I do wish I had the 2 step option because my UC returned in my recrum after step 1 and I had to expedite step 2.

Just take one step at a time. All the information can be so overwhelming. You don't need to understand the details of all of the upcoming steps. Just make sure you are confident with the decision of your surgeon and understand exactly what is happened in and what to expect with each step. I was an information addict before step 1. By step 3, I was so over it and just wanted it done. I couldn't even fully describe exactly what was going to happen.
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