hi, i'm confused. it seems like many of you here are happy with your K-pouch and would consider it a 'success'. but i've heard from 2 surgeons already that kock pouches are not recommended and they have a high failure rate (one surgeon who said this was from the Cleveland Clinic). so if the k-pouch is a good option, why are surgeons recommending against it? doesn't this discourage us to get one? thanx.

http://www.ccfa.org/info/surgery/surgeryuc

"...the surgeon must have great experience with the technique to decrease the high reoperation rate and overall poor outcomes of the procedure."

Flora,
I had this conversation so many times with surgeons and those who do not know how to do a k pouch seem to be stuck on the old valve issues. That is not the case any longer. The valve has been tweeked and perfected.
Dr Sung in Santa Monica said J pouch is more fashionable, if you willm=, since it is more normal to poop through the anus.
The Dr is not looking at what is best for each individual patients lifestyle or other possible reasons.
Since I have had a j pouch for 20 years I could say it is far from perfect but I learned to live with some Butt Burn and occasional frequency from foods. I have been lucky to not have pouchitis. I think that is more common in j pouchers than slipped valves are. K pouchers seem to have less problems as I see since my son had a k pouch I can speak from both sides as I experience both on a daily basis. He had his j pouch removed and is very happy with the k pouch even though the valve slipped in his case. He said he would never have wanted another j pouch and he is 21. We are all individual but surgeons sometimes don't see that. It si not a one size fits all operation as you can read here about fistulas, strictures, fissures, dilations, difficulty expellong, etc.
You are doing your reserach and you have to make the decision. Not the Dr who has never had an ostomy bag to change or a malfunctioning j pouch.
Their job is to operate. They have to pay the bills too!Maybe it comes down to the surgeon being incapable. They are all not created equal.
At any rate, speak to a few surgeons who do the k pouch about their success rate. I know a few who would be very willing to e mail with you or speak to you on the phone.
Also, frances.russell@baycare.org will take any questions in an ASK DR SHORE feature they just implemented, Fran will be happy to relay your questions to Dr Shore regardless of who does the surgery.
I hope this has helped you.

Flora - I don't know about the statistics about the k-pouch but there is over a 90% success rate with the j-pouch. It might be interesting to have statistics on all forms of pouches/ostomies: j, k, s, w-pouches, straight pull through, BCIR, Brooke ileostomy and any that I've forgotten. Because the patient success rate is so high with the j-pouch, I'd imagine that's why you're hearing that the k-pouch is not recommended.

I think that most people opt for the j-pouch because it's the system that most mimics what is natural. But the j-pouch isn't a one size fits all. We have members here who opt to stay with their ileostomy without ever trying anything else. They're perfectly happy (and good for them!) Others were not able to have a j-pouch because of complications. Cynnycal (Becca) wanted a j-pouch but because she had FAP/cancer there was too much damage to her rectum/anus (as I recall). She has a k-pouch and she's happy with it. Bill J, our Big Daddy/Moderator, initially had a j-pouch which didn't work out and he opted for a k-pouch. I think he's had to have some sort of repair surgery but I can't remember what it was. Some people have k-pouches - and they've had them for decades - because the j-pouch hadn't yet been developed. Others with failed j-pouches revert to an ostomy and they're perfectly happy - like JillM, Shell Worrall and others who don't visit here as often because they're out living normal lives.

What you pointed out about obtaining a surgeon with great experience is absolutely true (but I'd suspect that one would want a surgeon with great experience no matter what type of surgery is performed, right?). If you live in an area where there are skilled k-pouch surgeons and there will be skilled k-pouch surgeons taking their place when they retire, then a k-pouch may be a great option. It seems like fewer surgeons are learning the technique and I wonder if that may be problematic further down the road and/or life of the k-pouch.

Pouchitis seems to strike all pouching systems - j-pouch, k-pouch, and BCIR. However, pouchitis is rarely chronic. I have an 18-year old j-pouch and have never had pouchitis. Most people have an occasional bout of pouchitis which is cleared up with a course of antibiotics. Even those with chronic pouchitis do perfectly well staying on long-term medications and taking probiotics. If one doesn't want to ever experience pouchitis I think a Brooke ileostomy is the way to go.

One other consideration with this surgery is whether or not you plan on bearing children. It's been found that staying with an ileostomy might be a better option until after child-bearing. It's more difficult getting pregnant with a pouch then with an ileostomy.

Oh, and one MORE thing - I'll just bet that people with 'normal' plumbing, i.e., colons - get to enjoy some decreased functionability or increased problems with their regular plumbing. As we age, certain foods may be much more difficult to digest or they may cause gas or increased diarrhea or increased constipation or hemorrhoids. I don't think we pouchers/ostomates necessarily have way more problems then some of the general population.

I'm sure you know that none of these systems is perfect and you just have to do your research and make your best educated stab at what you feel will work best for you. So talk with doctors who perform all the various permutations of the various surgeries. And go with whatever feels most comfortable to you. It would be so wonderful to have that crystal ball and see what the future holds with whatever decision we make. Now THAT'S something someone should invent!!!!

Good luck with your decision.

kathy

It's only a good option if you can find a skilled surgeon, if you can travel or find one within your area. Many folks in this forum thrive with any ostomy type, but it's a personal choice. If someone (like me) has lost their rectum, the only ostomy option had been the ileostomy.

Please check with your gyno dr and surgeon if you are worried about child bearing, but when I was 21 with an ileo and meeting with the surgeon for my kpouch, they all said that my kpouch will have no bearing on concieving.

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