hey, just curious. I know there are some people on here who have had 2 j pouches created, and maybe even some who have had this and then gone to the ileostomy. So, my question is this- how much does stool consistency change after the removal of more small intestine and also how does this relate to nutrient absorbtion? In addition, how much can you actually remove before you have to be concerned with short bowel disease?
I know we all have a different amount if small intestines, but I am just looking for a rough estimate and an idea of how things chnage with the more you remove. Thanks!!
Andrea

A pouch takes 6-12 inches of small bowel. You have about 20 feet of small bowel. Strictly speaking, you don't really get short bowel syndrome until you have 10 feet or less of small bowel. However, they generally will not do more than two pouch procedures.

Jan

I have always been mystified as to how Thomas had a new second pouch made without "any significant loss" of additional bowel, because I thought the termial ileum was an important section, at least for absorption of B12. But it apparently has not had any effect--unless it had something to do with the bile salt re-absorption and GB problem.

The terminal ileum is very important for B-12 absorption. However, I have not been able to find out anywhere how long the terminal ileum is considered to be, but the ileum itself is about 13 feet long. From what I gather, it is the last several feet.


According to this study, loss of less than 20cm (around 9 inches) would not cause any B-12 deficiency. In those with a 20-60cm loss (9-27 inches), 52% had issues of B-12 malabsorption. But, there was no clear correllation between the length resected and the malabsorption. So, I guess it is individually variable. I also presume that this is why they feel it is safe to redo a pouch once.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&d...095407&dopt=Abstract

Jan

Not to beat a dead horse, and maybe this is obvious--but is the section used to make the pouch considered "lost", or is it still effective, since it's still "there"?

It is not considered lost unless you have chronic pouchitis or actually lose it to a redo. However, that said, it is understood that the pouch mucosa changes on a cellular level over the months to become more like colonic mucosa. So, in that sense, there is a loss of of general nutrient absorption, but not a total loss. This happens to all of us, to varying degrees, regardless of whether or not there is pouchitis. This occurs with end ileostomy too.

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365...33.x?journalCode=his

Good question actually.

Jan

ok, what??? I am having trouble understanding this... so if you get a permanent ileostomy due to problems with your pouch, don't they remove the pouch- in other words, they don't save and decontruct it to make it the point in which the end ileostomy comes to the skin?? Do they?? Maybe I was totally misunderstanding what you guys were saying.
Also, if you have a pouch re-do do they remove the old one?
just curious! Thanks!
andrea

Im having trouble understanding also. What exactly is a pouch "re-do"? Is it fixing up and altering in some way the old one once it is damaged or is it excising the old one and making a totally new one? In order for the latter to occur, I assume the rectal sphincter muscle must remain undamaged from any trauma that necessitated the re-do in the first place. Who besides Fazio is well known for successful re-dos?

quote:

What exactly is a pouch "re-do"? Is it fixing up and altering in some way the old one once it is damaged or is it excising the old one and making a totally new one?

I think when some part of the pouch is salvageable, it is more appropriately referred to as a "pouch revision", whereas the "re-do" we're talking about in this thread means removing the original pouch and constructing a completely new one from another length of bowel.

quote:

... so if you get a permanent ileostomy due to problems with your pouch, don't they remove the pouch-

Yes.