Hi All,

I had obstruction from 2 weeks ago i hardly can pass stool even it was liquid and finally i couldn't at all.

My Doctor Said after he saw the CT Scan


"The patient C.T. which clearly shows that the pouch is much dilated with long efferent limb.

It also shows that over a rectal cuff is still present.

I have no doubt the patient problem is secondary to the long efferent limb that allows the pouch entry to be kinked and obstructed.
I believe he will require surgery aiming of shortening the efferent limb.

This might be done through the auns or through the abdomen, depending on the technical feasibility.

Also the operation might be done at one stage or might have done staged according the local bowel condition at surgery."

In fact i don't know what to do

i go every 3 days to to make evacuation to my pouch

and i was prepering my self to go to NY and meet Dr. Bauer and Dr. Milsom and i already got the VISA and tickets

but i really can't see my self go to NY without knowing or even can find a place to rent or to stay with my such problem.

I really don't know what to do

I'm thinking in go a step back to and make ileostomy procedure again until i go to see these Doctors or until Dr.Fazio get back from his vacation in 12 of July.

or it's simple as the Dr. write in his report

I don't know??!!

I need an advice

It sounds simple, sort of. Simple in that this is an identified structural issue (by the way this is one of the reasons that the s-pouch fell out of favor and is only used in select people).

It does not sound like you need a completely new pouch, but a pouch advancement. This is where they disconnect the pouch, remove the long efferent limb (this is the length of ileum that leads from your pouch to the anus), remove the too long rectal cuff, then reattach the pouch to the anus. This will prevent the pouch from collapsing over upon itself, causing an outlet obstruction.

Are you saying that you have no qualified surgeons in Egypt that can handle a pouch revision? If not, before you trek to the US, send a copy of your records to Dr. Bauer and Milsom and get an opinion in advance. This way you will not have to waste precious time and money here. Hopefully, they can then have your surgery scheduled and do your preop workup a day or two before the surgery.

Getting a diverting ileostomy would certainly buy you more time, but it would be an extra surgery.

Jan

Hi Jan,

My S-Pouch Surgery here was full of mistakes (Abscess) and also this operation isn't famous in Egypt the doctors here didn't parctice it many times as in US (2000 operations and more in each Dr. CV).


I already sent my Reports to Dr.Bauer and Dr.Milsom and i had an appointment with the 1st on 18 of June and the 2nd in 20 of June and i bought a ticket which gonna reach JFK in 17 of June.

and i'm afraid to take such risk to travel by myself to a country i know zero about it.

i guess i'm in a Critical situation and i cann't take a decision!

I know that even though we know exactly what we need to do, it is very difficult to pull the trigger, so to speak. This is even when we know that inaction is worse than anything else.

I would contact the doc's offices regarding temporary housing (usually they have discounted motels nearby). Granted, you are arriving in two days, so this is planning that should have been done weeks ago.

Is there anyone here that can give our friend here some guidance about how to get oriented in the Big Apple for this important evaluation? I know several members have used these docs, so they can probably help calm your nerves.

Jan

U r right regading that i should be prepared more better than this but the obstruction happens in only two days then i founded my self cann't evacute it didn't gave me much time to make the right steps anyway

today i visited the doctor and he adviced me to make ileostomy again for two reasons

1st give me a time till Dr. Fazio came from his Vacation

2nd Pouch revision better to be done after the pouch Collapse again (leave her 1 to 2 months till it gets smaller) so they can make it according to the standard size of j-pouches

and i guess that well give me time to get prepared well and gaining some weight and health before doing another Surgery.

Sounds like a reasonable plan, particularly since it buys you virtually unlimited time.

Jan

Hey Simple Me, I've been your position before atleast when it comes to the problems you have. I had an S-pouch made with several complications afterward. After my first takedown I went about 7 months with those symptoms my original surgeon could not figure it out, I finially visited Cleveland Clinic where I saw both Dr. Bo SHen and Dr. Fazio. After a couple test they found my problem to be same as yours a long efferent limb and my pouch abnormally larger due to not evacuting. It was very hard for me to get gas or any stool out. When I sat down I could only get a minimal amount out and had to stand and walk around to get anymore out. Dr. Fazio advised and decided I should do the surgery in two steps. First surgery which took 4 1/2 hours, not as simple as it may seem, he made the limb smaller and I believe revised the pouch a little and reconnected it to my anus. He gave me a temp. ileostomy for about 3 months. He then performed the second surgery which was the takedown. I feel for you I went through a lot through a total of 9 surgeries, but that was one of the worst times, you can't eat without feeling horrible yet your very hungary. It's a position I would wish on NO ONE. I hope you can find a doctor to fix this for you. As for me I feel much better, but lately feeling a little worse going to cleveland clinic next week to see if I have a stricture. Good Luck anymore questions feel free to ask.

Hi Mark,

I'm Sorry for all what happend to u.

This is my 1st day out of the hospital they made me the ileostomy again, anyway thanks God for everything

I heard that shorting the efferent limb could be done through the auns, did Dr. Fazio Did it to u through auns or throught abdomen ?

I wish you the best of luck in your visit to cleveland the next week

Through the abdomen. Kind of sucks but kind of nice for me as I had so many surgeries I had a huge scar there about 3-5 inches wide. So after Dr. Fazio was done he had someone pull me together real tight and stictch the scar to a much smalled length. The only bad thing is my stomach was strecthed so much it was pretty painful recovery next couple weeks.

Hi Mark,

I had some questions for you

what is the opening size (lenght)?

did he do the operation on two steps (1st shorting the efferent limb and do ileostomy,2nd close the ileostomy after while ) or he did it all one shot?

how much i shell expect that well cost me?

Just got back from cleveland last night. I ended up having a small stricture near the outlet which my GI Dr. Shen then dialated for me. So it was a successful trip for me there. About the inscission, I don't know if you had laproscopic or not but I didn't and they cut about the same length as when they took out your colon. Haven't really measured as some people's torso are longer anyways, but for me about 3 inches above my groin to about 3 inches above my belly button. I had it done in two steps One which took 4 1/2 hours to shorten the limb and to make the ileostomy, and the 2nd just the takedown. I waited about 2 months and 3 weeks. I had it taken a week early because my diverting ileostomy turned into a non-diverting ileostomy I had my going to my pouch then out of my ostomy. I'm hoping you have insurance. But I mean I think it's like $1,200-1,600 for a hospital room each day.$2,000-4,000 for anesticia. Somewhere around 5,000 to 10,000 for the operating room. And another 2,000 for supplies and everything. So it all depends on what insurance picks up or how long you stay or how long the operation takes. Or how much medicine you need. Anyother questions just ask. I'm feeling a lot better now after the stricture got taken out 200 times better then I was with the efferent limb problem.

Happy to hear that you feel such good

Hope for you to keep this feeling forever

Good luck