2 vs. 3 surgeries for a jpouch

I've met with two surgeons now and while the first one suggested that he will do the operation in 3 stages the other one preferred doing it two stages. I am curious what you guys think is a better option? What are the pros and cons of each option?

I am on 20MG of prednisone since August and a biologic (Vedoluzimab). While my UC is not in remission, I have seen worse days.

My husband's surgeon said he would not make the call till he had opened my hubby up. He said depending on how things look on the inside... that will determine if he could make the pouch right away or not. This seemed like a more experienced and informed decision when we were consulting with the surgeon.

Once he got inside him, he said everything looked good and he was able to do the pouch and the colectomy at the same time.

Some people swear by the three step saying your body handles it better but my husband is very happy that he doesn't have to have a "major" surgery for a second time and glad he got it all over in one step. He did have some major complications from it... but we are happy with the two step.....so far! We'll see after his take down. :D

But definatley go with the surgeon that has the most knowledge and experience. The thing I liked most about our surgeon was not that he did his surgery in two steps but he was knowledgable enough to take care of my husband when things did not go according to plan. You want someone good that knows what they are doing when the fhit hits the shan!

I think Sue's advice is the best.

My surgeon at the Cleveland Clinic (considered one of the best) had me do three steps. But I was very sick. I was on 40megs of pred for the month before. I was on 20 for several months before that. In fact, I'm having to wait a minimum of 6 months in between step 1 and step 2 to get the pred out of my system. I don't even think the dosage mattered to them - prednisone for months = 3 step.

The negative is having three operations (two of them major). That means more risks, more pain over time, more drugs, more waiting, more time off of work, and more bills.

The positive is each surgery is not quite as harsh on you. Now, don't get me wrong...they are hard surgeries but I've heard that the colon + jpouch creation combined is a bit of a butt kicker. With the three stages, you get the "bad" colon out. You start to feel a bit better. Because the pred is gone for the second surgery, your tissues are less delicate (and better for the surgeon to work with), and your jpouch will heal better.

here is my 2 cents...
i had an emergency total colectomy in march to save my life. bad UC and almost hemorrhaged to death. ick.

well, 6 months later i get to chat to my new surgeon and discuss the jpouch. he said it is okay to do it in 2 or 3 steps, but 3 steps gives your pouch the time to heal without having to do anything else.

i opted for 3 steps. i did not want any single thing to even jeopardize this whole thing from being as successful as possible with no complications.
the loop ileo was no big deal really and the 3rd surgery ended up being less than 2 months after the jpouch surgery.

i would not change a thing. i can't imagine going through the healing from the 2nd surgery and having to learn how to use my new jpouch at the same time.
surgeon also said giving it time to heal also you puts you in a better position to not getting things like pouchitis etc... doesn't prevent, just helps.

having done all 3 surgeries just in the last 9 months, i am happy i did it that way.
baby steps. especially when our bodies have been sick with disease i think it best to go slow and give your body the best chances and time to heal.

Thank you for all the great advice!! I have a consult with a third surgeon scheduled on the 31st. He is very well known and has been recommended by several people. Let's see what he thinks is the right approach and I'll definitely bring it up with him that I have been on prednisone for a while.

I would say that 3 versus 2 does not indicate the skill of the surgeon...just the preference. My surgeon is a leader in the field (he successfully fixes patients' messed up jpouches) and he said to go with three.

I too have heard that those who get a three-parter have better outcomes. I believe I've read it from other patients and heard it from my surgeon.

I had three steps. The first step colectomy was easy. I was kept very well doped so no pain, the incision healed super fast and I was demanding real food on day 3. This would have been much more difficult if step 1 and step 2 were done together.
Step 2 was a bit more stressy, and I really hate to think how I would have felt if both had been done at once.
Step 3 was easy for me. I had no gas and things started working about 36 hours after surgery. It is possible to have extremely painful gas pains, bloating, vomiting and a bowel that won't wake up. These problems will come up regardless of whether it was a one or two step.
I really think it is better to look at the whole picture of your life and health goals when you make a decision like this. I am really very glad I had 3 steps and I know my surgeon had the best outcome for me in mind when he said he would under no circumstances do 2 steps.