Surgery question

Hi,

I have ulcerative colitis, and am due to have surgery in about three weeks. I'm in the UK, at a university hospital, and my surgeon is highly regarded in his field.

My surgeon is talking about a two step surgery for me. In the first surgery, he'll perform the colectomy and create a temporary ileostomy. In the second surgery, he'll reverse the ileostomy, and create and connect the j-pouch. Apparently none of the surgeons at my hospital form the j-pouch in the first surgery anymore.

However, he says that in the first surgery he'll leave the rectum present (in its entirety), which will then be reduced to a rectal cuff in the second surgery (when he'll form and connect the j-pouch). He said that if there's still active colitis in the rectum after the first operation, it tends to get a lot less intense when there's no faecal matter passing through (so it's just some blood and mucus) and that it can be treated topically.

Has anyone else had that experience? If so, how did some lingering rectal inflammation compare to normal UC pre-surgery? How easy is it to control when you release the blood/mucus?

Thanks in advance,

Albannach

Post Edited (Albannach) : 5/20/2016 8:49:45 AM (GMT-6)

Thanks for this. According to the surgeons here, the overall outcomes are good when the pouch isn't created in the first step. By step two, you are systemically well, not on steroids, immunosuppressants or biologics, etc. So they see it as the best time to create the pouch. Like I said, none of the colorectal surgeons here create the pouch alongside performing the colectomy in step one.

If I understand my surgeon correctly, there is no medical reason why a newly created pouch cannot handle bowel products. Bowel cancer and FAP patients commonly have a one step j-pouch surgery, and are able to use their pouches immediately. People who have bowel resections also start using their newly joined sections of bowel right away.

Glad to hear you're happy with your j-pouch. I hope I can say the same soon!

I had 3 steps. The 2 step is usually the colon removal and jpouch creation as the first step and the connection as the second step. I am happy I did it in 3 steps because the first step was a tough recovery for me and if I had the pouch creation at the same time, it would have been that much more difficult.

I guess you have to do whatever the surgeon recommends. I would consult with a couple surgeons and choose the one you're most comfortable with and who has the most experience. If they give you the OK for the 1 step, I don't see any reason not to do it. I wasn't offered that option and I wasn't interested in traveling to get it so I did 3 steps and took my time. It was a pain in the ass going under 3x, also there is a lot of time in between where you're in limbo. The one step really appealed to me, but when I met the surgeon I felt comfortable with, he said 3 steps...

After step 1, people said I should ask my surgeon if he would do 2 and 3 at the same time - which is what you're describing. I guess it's not THAT uncommon. I didn't ask. I don't think he would have done it. He's very 'by the book' and my surgery was planned the way it was for a reason so I don't think he would change paths in the middle.

I had to wait much longer, 10 weeks. I was basically begging to get in there, I was excited to move on from my diseased colon. Other people have different emotions about surgery but I was mentally ready to move on because I had tried most medications.

I don't have a jpouch I have a permanent ostomy but I remember feeling like you before surgery. Surgery was what I wanted but when the surgeons secretary called and gave me my date and it was only a week away I thought whoa this is it! Am I ready for this? But what I remember most is how at peace I felt when I woke up. Once my diseased colon was out my body felt so calm. My surgeon said a lot of his patients feel that way after surgery.

atwoodt said...
This is the first I've heard of forming the j-pouch on the second of two surgeries. There is a lot of stapling involved with j-pouch formation and the vast majority of surgeons want the j-pouch to heal over an 8 week time span before putting it to work. As others have mentioned, typically (in the US at least) the colon is removed and jpouch is formed in the first surgery, leaving you with a temp ileostomy and the second surgery involves "taking down" your ostomy and reattaching your small intestine.

Best of luck.

The staples is what caused me an issue. One of the staples came free which caused a tiny leak and in turn caused my abdominal abscess. I could of had a much worse infection than I did if it was stool leaking out of that hole. We were very adamant about making sure the pouch was sealed via xray before he would reconnect anything.

Based on your profile name I'm guessing you may have the op at the same hospital I did, unless you're a Scottish ex pat!?

The rectal blood/mucus was fairly easy to control for me, no "accidents" and could pass it with little pressure. It is an odd feeling but not painful and you get used to it. Enemas can help :D

I'm sure you've done your research but take it easy on the food after surgery and hope it goes well.

This is becoming more and more common in the UK. Many surgeons now prefer this new modified 2 step process.

Albannach said...
I saw my surgeon a couple of weeks ago to discuss the j-pouch surgery. He says I'll have a rectal catheter in for the first five days post-surgery, which protects the anastomosis in the initial period of healing. After that, and assuming no further complications, it is ready to use.

wow, interesting....I didn't have that. Sounds like a great idea though. I dealt with a stubborn stricture at the anastomis site post takedown. It was resolved relatively quickly but what a pain in the butt....literally.