I had a complete colectomy with end ileo back in February, expecting to complete the j-pouch process in 3 steps. I have a new surgeon now because I'm in a different state, and she wants to try to do the rest all in one surgery, skipping the diverting loop ileo altogether. It seems that the 6-8 weeks between j-pouch construction/loop ileo and takedown is pretty standard for most folks. As excited as I am to possibly be done with the ileo after my next surgery, it seems risky. I trust my surgeon, but I'm a little nervous, and was wondering if I could hear from anyone here who skipped the loop ileo and opened the pouch up for business right away (especially anyone who had a GREAT experience with it ). Thanks!

OK now I'm worried that anyone who had this done (no loop ileo) had a terrible experience and doesn't want to reply and scare me... anyone??

While my situation was different, there were some similarities. My surgeon wanted to perform a one step. My GI doc, when I told him, said, "Absolutely not!" You have been on Prednisone too long (3 years) and your age doesn't support having this surgery in one step. I was 61 at the time. He said my healing would be compromised because of both factors. I shared all this with my surgeon and insisted on having a two step. I even chose to keep my temp. ileostomy for a full year. Believe me, I was well healed when I had the takedown! Maybe your new surgeon sees you as healthy enough to complete the entire surgery during the second step instead of stretching it to three steps. Guess I'd want to know why my first surgeon wanted to go the three step route and compare his reasons with why your new surgeon wants to do it in two steps....almost like a one step. Keep us informed.

My understanding is that my first surgeons in Michigan wanted to do 3 steps for the same reason you describe--I was sick and on steroids, so they wanted to get in and get out without trying to make the pouch. My surgeon now is a bit younger and trained differently (for example, she does mostly laproscopic and my other (older) surgeons do mostly open), and I guess she's more willing to do things that the older surgeons might have thought were too risky. That said, I think the first surgeons were most concerned with doing the colectomy by itself, and it just wouldn't have occurred to them to think that steps 2&3 might be combined (pouch construction and final takedown). Because most 2-steppers do 1. colectomy + pouch construction and 2. takedown, they were thinking of it in terms of splitting the first step into two, leaving the takedown to be done as a 3rd surgery. In other words, I'm not sure the first surgeons necessarily would be opposed to me getting the pouch construction with takedown and no diverting loop, they just felt strongly that the first step should be colectomy only due to the high steroid load. I got the impression that doing a temporary loop ileo with pouch construction (whether it's in the first step or the second) is just their practice--the way they trained and the way they've always done it. Sorry if that is confusing, this is hard to describe. Basically, I'm not necessarily concerned or surprised that the surgeons see it differently. My current surgeon did make the point that if I'm going to try and go for the pouch+takedown in one that I need to get myself in really good shape and well-nourished beforehand.

ETA: I am 31 years old and otherwise healthy, so that wasn't/isn't a big factor.

I had the 3 step due to severe friability of my organs and tissues due to prednisone. I can't comment on the one-step but do remember my colorectal surgeon at Mayo saying what a markedndifference there is in the tissue healing between weeks 8-12 before takedown. She would not touch anyone who was not at the 3 month mark between j-pouch formation and takedown. Her speciality is labroscopic/minimally invasive surgery.

There are some successful one step j-pouchers here on this site. Hopefully, they can help you weigh the risks.

A surgeon never wants to risk anything so it's a great thing if she feels that you are a candidate for this. Once on the operating table, the surgeon might decide that it's not the best thing, and go with the loop ileo. Most surgeons don't want to go the 1 step route because of risk of infection and also for the fact that they don't have much experience with it. If she has done them with good results, then I'd so go for it!! It's not going to save you an ostomy since you've got one now, but cutting out a surgery is huge!

There are one-steppers out here with success, but I think they say less than 1% are performed this way so you might have a hard time finding a lot of positive stories. Trust me...if my surgeon would have offered the 1 step surgery, I would have jumped on it in a heartbeat. He told me the only place that really did them was Mayo (which obviously isn't true since your surgeon has done them). It was really important to have a hosptial close to my house and family so I just stayed in Chicago.

That's funny... my surgeon trained at Mayo! So, not entirely untrue, I guess. I'm certainly not going to elect for the loop ileo if she wants to try to skip it, it's just a tiny bit disconcerting to know that this is almost never done. Thanks for the input!