Have been meaning to post this for a while. My last surgeon visit he mentioned that he preforms the " hand-sewn " for the j-pouch. I've read a few articles on the net but still not sure what the difference is between that and stapled j-pouch.


Looks like it's a wash as far as I've been able to learn .. that is to say there really is no difference in out come for the patients down the road as far as recovery and long term out comes with the j-pouch.


I wonder if the hand-sewn type of surgery requires more of a " reach " then stapled created j-pouch. For those that remember me .. I'm waiting for " step 2 " because I'm needing to lose weight so the j-pouch can " reach " ..

Any feed back from those here on these two types of j-pouch creation ?

Mark - I don't know the difference but Jan had hand sewn so maybe she'll be able to answer the question.

kathy

I had a double staple technique, the first actually done by Dr David Jagelman. My pouch is 19 and I have never had pouchitis.

My daughter unfortunately was stapled and her ureter was accidentally severed by a staple and a fistula was made also by the stapler. There was a staple attached to the severed ureter, and the hole was the shape of the stapler. This would not have happened had she been hand sewn.

There are risks and benefits to both types of suturing. With the stapled, there is the risk of misfiring staplers and local reactions to the staples. Plus, there must be a short rectal cuff for attachment. With handsewn, mucousectomy is possible (not possible with stapled), but there is more of a risk of damage to the rectal sphincters due to prolonged periods of anal dilation to perform the more complex procedure.

Stapled has become more mainstream because it is easier to teach and learn, so the procedure can become more widespread. Risk of cuffitis, dysplasia and cancer in the retained rectal mucosa is very low in most cases, but if you had a preop diagnosis of rectal cancer, dysplasia, or FAP, a mucousectomy would be required, and the stapled technique would be contraindicated.

Jan

My daughter has the stapled, but also did have the mucosectomy at the same time. This is not commonly done by surgeons, to do the stapled & mucosectomy, but this is what she has. She has FAP, which is why they wanted to do the mucosectomy. She has no control issues and 3-4 bm's a day. (She's 15)

I have a stapled pouch and have a fistula from a migrating staple. I am having a hand-sewn pouch redo in September in Cleveland. I think now that it is weird to leave hundreds of metal objects in the abdomen. It just seems inevitable that fistulas would happen with the stapled pouch.

I also had a mucosectomy and was passing lots of staples between steps 1 and 2, so I assume mine was also stapled. I'll ask my surgeon the next time I see him.

Very interesting! I do know that the more widely used technique, double stapled, does not allow for mucosectomy. However, a single stapled connection could be preceded by a mucosectomy. I did not think this was used anymore.

Most people do not react to the staples, otherwise it would not be as widely used as it is in so many GI procedures. Plus, overall, the functional outcome is generally better without increased complications.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=...anel.Pubmed_RVDocSum

Jan

Mine did staples. Something about lasting longer and no leaks.

My daughter has a stapeled pouch and it is 8 years old. She did develop cuffitis after about the 3rd year and she has had it under control by taking pentasa and sometimes but rarely canasa suppositories. She has always had excellent control right from the beginning and has always had about 6 movements a day, but I have seen her hold it in for up to 10 hours and she does eat. Her surgeon told us at the time of her surgery that being she was so young,16 at the time, that he felt more comfortable leaving some cuff so that she wouldn't have to worry about leakage, that is a concern when stripping the cuff and hand sewing. She does go for annual scopes and biopsies, but she is glad to be able to hold it as long as she does and fears some day needing the cuff stripped and maybe not having the control she does now. Hopefully that will never happen, but with her having cuffitis it is a possibility. Not everyone with a cuff gets cuffitis but just letting you know that it is livable, for her anyway.

I have yet another combination. I have a hand sewn pouch with an unstripped rectal cuff. I did also develop cuffitis, but it is controlled with maintenance therapy. My pouch will be 12 years old in August.

Jan

I have a stripped cuff and a hand sew. I had incontinence issues early on but that was due to a traumatized sphincter and was corrected. I am 6 years out and no problems.

Sue

Ok, Jan - I know we've discussed this before:
Here's the link:

http://tinyurl.com/2n5jxp

I'm still a bit confused. So, would you think my daughter has the double stapled with mucosectomy or single stapled?

Ranae, I just don't know. Since I am not a colorectal surgeon or even have any recent surgical experience, I am not familiar with the various staplers used now. So, I would not be able to tell if a surgeon used a single or double staple technique. But, obviously, she had the mucosecomy and a stapled pouch.

Jan