Hello,

Has anyone here had the j-pouch surger in Denver and can recommend a surgeon. I'm seeing a GI doc for a 2nd opinion for my colectomy for high-grade dysplasia in my ascending colon and I dont know who either in Denver or Colorado Springs to try to schedule surgery with. I'll ask the doctor today, but it's always good to hear from someone who's had the surgery and get their opinion.

Thanks,
Rick

This message has been edited. Last edited by: RickR,

Hi Rick. I just had my rectum removed on June 6th and at the same time had a j-pouch (in colon) created with a temporary ileostomy. I had mine done in the University of Colorado in Denver by Dr Martin McCarter. They have the latest in technology, equipment, labs and research. Both my oncologist, Dr William Robinson, and surgeon, Dr Martin McCarter, work there. I was recommened to them by several nurses, my GI doc and other doctors. He even has a good bedside manner! He also answers questions promptly too. If you'd like their contact info please let me know.

Best of luck to you, Judy

Thanks for the posting Judy.

I ended up seeing 2 surgeons in Denver: one who operates at Lutheran Hospital in Wheat Ridge, and the other at Colorado University Hospital in Denver.

The first surgeon does a lot of j-pouch surgeries, about 50 per year, over 900 total, and he said his last 100 or so were done laparoscopically. He does what he called IAPT or Ileo Anal pull-through, and said by not leaving a rectal cuff the risk of colon cancer will be completely removed. He also told me I would be a candidate for a 1-stage surgery so there would be no temporary loop ileostomy, if he is able to complete it in one step.

The second surgeon, on the other hand, said that he leaves a rectal cuff, with mucosa intact(though if I requested, he would do a mucoscectomy), because there is less risk of sexual dysfunction and continence issues by not removing all of the rectum. He does the surgery in 2 stages and with an open incision.
He also gave me the option of an abdominal colectomy with ileo-rectal anastomosis, because there was only part of one biopsy that showed dysplasia and it came from the ascending colon. The sigmoid colon and rectum looked clear, from the colonoscopy report, and the biopsy report showed no cell abnormalities from UC in these areas either.

So, I'm wondering what everyone thinks about leaving the rectum behind with annual surveillance to watch for possible future inflammation or dysplasia, with an option for j-pouch later, or should I bite the bullet and go for the j-pouch now? And if I go for the j-pouch, should I go for the Ileo-anal pull-through or leave a rectal cuff?

Hey Rick,

I would choose surgeon 1. He seems much more experienced. Based on my extensive research prior to my surgery, I felt that a mucosectomy was the best route. In general, it is not as common as leaving a rectal cuff because it is much more difficult for a surgeon to perform. If you surgeon has lots of experience with mucosectomies, then all the extra risks of complications are about the same as leaving a rectal cuff. I am not sure if 100 laproscopic surgeries are enough experience. I would tell him to try laparoscopic at first, but if he has any doubt at all, do the traditional open route. Laparoscopic would be awesome. Same thing with the one-step.

If you have IBD and dysplasia, you want as much live colorectal tissue out of you as possible. I believe that 25%-50% of people with dysplasia in a colonoscopy already have a cancer that was missed. More than likely it is in the very early stage, but still a scary thought. Colonoscopies are good, but not perfect. Leaving the rectum in place does not make any sense? In addition to the likihood of Colitis returning in that area, you are exposing yourself to a higher risk of cancer down the road.

Check out this link - some info on IBD dysplasia and colon cancer

http://www.vioworks.com/Player/key.asp?p=4973

Hi Rick,

I'm also deciding between the surgeon in Wheat Ridge (probably the same one) and another at the UC Hospital in Aurora (again likely the same one). I'm leaning also toward the more experienced surgeon.