I`ve had my jpouch for 6 years now.The thing that is nagging me is all this talk about 1,2,3,step surgeries.I hear people who had 1 step surgery,a 2 step surgery,which I had BTW,and 3 step surgery.The thing that confuses me is talk about making the pouch heal in the 3 step type surgery and then going in for the TD.The 26,000 dollar question for me is what about us people who only had a 2 step surgery that is,removal of the colon in step 1 and creation of the j-pouch in step 2.When did the pouch have time to heal in step 2,I started going to the bathroom the second day after surgery because the damn nurse pulled my anal tube out accidentally while giving me a sponge bath,I thought they were supposed to be relaxing,I digress.Am I to understand that because of this,this is why I`m having all the problems I`m having with pain and all.Did the pouch have time to heal in my situation.? :confused
Oh I forgot to mention what about those that had a 1 step surgery how did their pouches have time to heal?

At the time of my son's surgery, the surgeon at UCSF told us that bowel tissue heals very quickly and that over a 10 year period they had observed no statistical difference in healing success between pouches done in one step and those done in two. Usually by the time peristalsis resumes, the pouch has healed enough to handle it. Past the immediate post-surgical period, when healing issues are most likely, I doubt that the lack of "healing time" six years ago would be the cause of any long-term problems you are having now.

In three step surgery the surgeon does a colectomy, then formation of the j-pouch, then takedown. The only difference with the 2 step is that colectomy and and j-pouch formation are done in one step. The only reason some people need a 3 step procedure is if the person is really malnourished or anemic when they have their colectomy they need time to regain strength and health before the j-pouch is constructed to increase its chances of success.

If the person is pretty healthy, they can handle the colectomy and j-pouch construction in one go and the j-pouch is given time to heal before the takedown.

1 step:

Removal of colon and creation of j-pouch. No ileostomy.

2 step:

a) Removal of colon, j-pouch creation and loop ileostomy to allow j-pouch to heal.

b) Then takedown at a later date.

3 step:

a) Removal of colon only and creation of an end ileostomy.

b) Then j-pouch creation at a later date with formation of a loop ileostomy.

c) Followed by takedown a few months later.

Hope this clears up the confusion.

Shell

As KeithO said, I think those who need a three step are those who's guts are in too poor of shape, or they are otherwise not strong enough to do it in two steps.

I had a one step surgery. I had a rectal tube in for 4 days and then I started using my pouch. I was told that if the pouch has no leaks, and they check that in surgery, then it only takes a few days for things to heal.

janna

Anna Stomosis,

Your 2-step procedure is unlike most of the others here. Most people have the colectomy and pouch formation as the first step. You had just the colectomy as the first step, and no diverting ostomy after the pouch creation in the second step. This makes it more like the 1-step, but you were the beneficiary of having the diseased colon long gone before pouch formation.

Reconnected intestinal tissue heals within about 3 days, which closely corresponds to the time of usual postoperative ileus. Not having the diseased colon present should improve your healing.

It was most likely an unfortunate string of bad luck that is the real cause of your problems, since serious complications can occur even in the best of circumstances.

Jan