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2 step or 3 step?

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Ostomies
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Posted 4/3/2011 6:39 PM (GMT 0)
O, so I had a colostomy Feb 14, 2011 due to my Uc.  I'm real anxious to get it reversed and is only been 2 months! But I can't wait. The Dr. said Aprox 4 months and my GI dr said that I would only hav to have 1 more surgery and that was to "hook up the plumbing" . I had an appointment with a colostomy nurse and she said it would be 3 steps to do a j-pouch .. sSo what is correct ?? and what is the process togetting it done?? what's it like? eyes
Posted 4/3/2011 6:59 PM (GMT 0)
That all depends on how your surgeon does it. My husband IF he was a viable candidate when he got in there and operated, it would have been a 2 step overall process and not 3.

Some people need 3 surgeries if they are on prednisone, emergency surgery situation etc. Hubby was off prednisone for a very long time but his "innards" just were not good enough to construct a pouch and what good small intestine was left was not long enough.
Posted 4/3/2011 7:21 PM (GMT 0)
Yes, I was on steroids and have been off them for about 3 weeks now. I was on them for about 2 yrs before.
Posted 4/3/2011 8:37 PM (GMT 0)
I can't really give any advice, but on a similar note, I am curious about why some people need 2 and some people need 3 steps...what would they do in the second of 3 steps?
Posted 4/3/2011 8:59 PM (GMT 0)
So you had a total colectomy and now have an Ostomy? Did they form the j-pouch during your first surgery? Is so, you just need the reversal, if not the next surgery is the formation of your j-pouch then the 3rd surgery is the reversal. Did the surgeon not explain it all to you? I have my reversal tomorrow morning...yea! I know how you feel...you just want it over with.
Posted 4/3/2011 9:17 PM (GMT 0)
Definitely ask your surgeon - the surgery can be done in either 2 or 3 steps so you'll need to know which way he plans on doing it. If you were on prednisone for that long, my guess is he'd do 3 steps.

@80sChick: For the three step surgery, the first step is removal of the colon ONLY, they don't create the j-pouch. Second surgery creates the j-pouch. They basically separate out the first surgery (of the 2 step) into two separate surgeries. This reduces risk of sepsis if you've been on immunosuppressants.
Posted 4/3/2011 10:50 PM (GMT 0)
You will need to find out if your surgeon built your pouch during your first surgery or not. If they did, then you may very well only need one more surgery to take the ostomy down and let the pouch start working.

I am a three stepper because my first surgery was the colectomy only. My surgeon did not want to build the pouch now because I had been on prednisone and it makes the walls of our organs soft and makes it harder to heal. I am also a bit overweight and he wants me to lose the excess weight first as well.
Posted 4/3/2011 11:51 PM (GMT 0)
I was a 3 stepper because of both my steroid use and the fact that they had recently determined that if you are/have been on Remicade you have a better chance of recovery with fewer side effects/issues by doing it in 3 steps.
Posted 4/4/2011 12:31 AM (GMT 0)
Prednisone does make things (softer) and too diffucult to construct the pouch along with the first surgery which is the reason for 3 steps versus 2 steps as explained to us.

Hubby was off the prednisone for almost 3 years so that would not have been an issue and his surgery would have been a 2 step process if it turned out to be possible.

I am sure the doctors would prefer 2 surgeries whenever possible as would the person involved too but it all comes down to giving the j-pouch the absolute best chance of being successful overall is my thought.
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