Hi there! I haven't posted in years, as I've been putting off my surgery as long as possible. But, the time has finally come, & this is my big hitch so far- my GI & PCP recommended this surgeon to me- he is a general surgeon, specializing in advanced laparoscopic colon surgeries. My GI has also recommended a colorectal surgeon in the past- problem is, this guy is over 2 hours away from my home. Which isn't too bad, but getting to him for pre & post-op visits would be a nightmare, and if I run into any issues, it's another day of driving to see him. I asked this particular surgeon (the colorectal guy) about just this issue, & he told me that there are plenty of decent surgeons at my local hospital who could handle any troubles. So--- I'm planning to have the surgery at my local hospital with the general surgeon. But.. now I'm thinking "Should I go with a colorectal surgeon???". I trust my doctors fully, & know that they would not recommend him if they had any doubts. My GI is on vacation 'til next week, but I plan to talk with him & pick his brains about the local surgeons competence. It's not a jpouch, a proctocolectomy w/end ileo... I haven't met my local surgeon yet, but I plan to really pick his brains also. I suppose if I get a good feeling about him, then I should trust my instincts. Did the majority of you all get surgery done by a general surgeon or a colorectal surgeon? As far as I can tell there shouldn't be any complications- I'm pretty healthy overall, have not been on pred for a few years, & my UC is not horribly active at the moment.
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I don't know enough to advise on general vs colorectal surgeons, but I wouldn't dismiss the GP without getting more info. It sounds to me like you might feel better if you did some research on the doctors. Can you arrange to have a consult with each of them?
I know laparoscopy is the preferred method for most people. My surgeon suggested I choose to do an "open" suurgery instead of laparoscopic due to the "complexity" of my case. I have had chronic pouchitis since day one of my takedown about 15 years ago and am currently on Remicade because antibiotics stopped working for me. I still don't have a clear diagnosis of CD vs UC. I'm not sure which of these elements (or the combo) led my surgeon to describe my case as complex, but I wanted to let you know about my situation in case it parallels yours.
Regarding the distance, I have also chosen a surgeon out of my area (about 3 hrs away). I talked to him about how my case would be managed with distance and here's what we worked out:
I'll meet with my local ostomy nurse before my surgery and s/he will mark placement for stoma, discuss supplies, etc. That way I'll have a relationship already established for after surgery. My surgeon said I would be welcome to also meet with his ostomy nurse beforehand. His nurse will take care of my ostomy needs and support while I am in the hospital and i could also continue to see her indefinitely if i wanted to make the drive. We both agreed that that would only make sense as a back-up plan, but that I should do what is most convenient unless there's a problem.
He said my follow-ups with him would be until my wounds healed. He believes a lot of the aftercare surrounding this surgery can be handled locally. We will see how it all plays out and I have his assurance that I won't get lost in the transition, especially since there are possible complications from this surgery and aftercare will be important.
I also made sure I left the appt with a commitment from the surgeon about how he was going to stay in communication with my local GI. I think this is really important. I ran into slight difficulties with this 15 years ago when I was having trouble and the surgeon thought it should be handled by my GI and my GI thought it was a surgical issue. Having there be a geographic distance could also make this passing of the baton more tricky, so I wanted to get a plan in place in advance.
Good luck to you. I hope you get all of the info you need to make a decision and can then proceed with confidence.
I know laparoscopy is the preferred method for most people. My surgeon suggested I choose to do an "open" suurgery instead of laparoscopic due to the "complexity" of my case. I have had chronic pouchitis since day one of my takedown about 15 years ago and am currently on Remicade because antibiotics stopped working for me. I still don't have a clear diagnosis of CD vs UC. I'm not sure which of these elements (or the combo) led my surgeon to describe my case as complex, but I wanted to let you know about my situation in case it parallels yours.
Regarding the distance, I have also chosen a surgeon out of my area (about 3 hrs away). I talked to him about how my case would be managed with distance and here's what we worked out:
I'll meet with my local ostomy nurse before my surgery and s/he will mark placement for stoma, discuss supplies, etc. That way I'll have a relationship already established for after surgery. My surgeon said I would be welcome to also meet with his ostomy nurse beforehand. His nurse will take care of my ostomy needs and support while I am in the hospital and i could also continue to see her indefinitely if i wanted to make the drive. We both agreed that that would only make sense as a back-up plan, but that I should do what is most convenient unless there's a problem.
He said my follow-ups with him would be until my wounds healed. He believes a lot of the aftercare surrounding this surgery can be handled locally. We will see how it all plays out and I have his assurance that I won't get lost in the transition, especially since there are possible complications from this surgery and aftercare will be important.
I also made sure I left the appt with a commitment from the surgeon about how he was going to stay in communication with my local GI. I think this is really important. I ran into slight difficulties with this 15 years ago when I was having trouble and the surgeon thought it should be handled by my GI and my GI thought it was a surgical issue. Having there be a geographic distance could also make this passing of the baton more tricky, so I wanted to get a plan in place in advance.
Good luck to you. I hope you get all of the info you need to make a decision and can then proceed with confidence.
Eva Lou,
I had my pouch done by a C/R surgeon and all the follow ups too until I started to have serious problems a few years back and I ended up being refused surgery by the 'specialists'...I finally found a fabulous general surgeon who is a specialist in laporoscopic surgery and he has done my 4 last surgeries that way...it is a question of feeling good with the guy and feeling safe...
I trust him with my life. So, meet them both and make your decision after that...
Sharon
I had my pouch done by a C/R surgeon and all the follow ups too until I started to have serious problems a few years back and I ended up being refused surgery by the 'specialists'...I finally found a fabulous general surgeon who is a specialist in laporoscopic surgery and he has done my 4 last surgeries that way...it is a question of feeling good with the guy and feeling safe...
I trust him with my life. So, meet them both and make your decision after that...
Sharon
Sharon, I find it so interesting that you started off with a CR surgeon, & didn't have such luck with him! The fact that I'm not going for a j-pouch has a lot to do with my decision also- I expect a board certified general surgeon to be able to perform a proctocolectomy competently! Since I've met with the CR surgeon 2x now, my next step is meeting with the general surgeon- appt. is on 2/12/13. And speaking with my GI more in depth, also. I like your suggestions Lynne, about having a plan in place prior to surgery. I'm concerned about WOCN nurses, or the lack of, with the general surgeon. So that's going to be a major factor also... I just feel like in my head, I've been making this out to be a GIGANTIC procedure for the past 5 years, & in reality, it doesn't have to be. So by keeping it local, it seems more manageable... to me. But I do want to get the best care possible, so.... thanks for the feedback, I appreciate it!
Board certification is mostly just a way of knowing that the doctor has met the requirements of performing a certain number of specific surgeries, as defined by the board. It does not mean that surgeon is better or more competent than those without it. But, it does give you an idea of his experience level. General surgeons have to perform a variety of surgeries in order to get their certification, including bowel resections. Without the colorectal board certification, you may just want to do more homework. Talk to some of his patients.
One reason you may want the CR over general surgeon is the fact that the rectal dissection and closure of the anus is more complicated than you might think. Ask anyone here who went for pouch removal. If you are keeping the sphincters and anus I think you are OK with the general surgeon.
The main thing is what you and others think about his skills. The fact that other doctors think highly of the surgeon speaks volumes. My j-pouch surgery was done by a general surgeon and I was quite pleased with his level of skill, bedside manner, accessibility, and knowledge base. He was recommended by my GI, and ALL the nurses loved him (be wary of surgeons not well liked by the nurses- they are tyrants or divas, or both!).
Jan
One reason you may want the CR over general surgeon is the fact that the rectal dissection and closure of the anus is more complicated than you might think. Ask anyone here who went for pouch removal. If you are keeping the sphincters and anus I think you are OK with the general surgeon.
The main thing is what you and others think about his skills. The fact that other doctors think highly of the surgeon speaks volumes. My j-pouch surgery was done by a general surgeon and I was quite pleased with his level of skill, bedside manner, accessibility, and knowledge base. He was recommended by my GI, and ALL the nurses loved him (be wary of surgeons not well liked by the nurses- they are tyrants or divas, or both!).
Jan
just a quick update- I just talked with my GI, who told me my recnt biopsies came back ok, but they did find a ganglio-neuroma in my colon...??? He called up the pathologist for more info, & it's not something that would prompt me to get the colon removed ASAP, it's not "cancerous". But it sure sounds gross! I asked more ???'s re. the general surgeon, & my GI did reiterate that he thinks this guy is really good, a great surgeon, he does many proctocolectomie w/end ileos.... He advised me to go meet with him, see how I feel about him. So again, he thinks I will be fine with a general surgeon- if I were to go for a jpouch he'd advise a colorectal surgeon. So now, I wait 'til the 12th for my face to face with the genral surgeon. I've been posting this same question on lots of ostomy forums, & the answers are totally varied- some ppl. had terrible experiences with CR surgeons, some would see nothing but....
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Eva Lou,
A little clarification...I didn't leave my colorectal surgeon...I moved to France and seeing him became a very expensive process although he has never charged me for a visit...I have to fly in for a check-up (about +5000miles) so it was not a monthly thing...when I started to have serious pouch complications and my First French surgeon gave up on me I found a 2nd one (colorectal) who appently was not the most pouch-friendly kinda guy...the surgery was a collosal failure (I could not intubate my k pouch without causing a major hemmorage and could only doing it laying flat on the floor...he considered that 'unimportant details'...I could not lay on the floor and intubate at work so I had to stop working)...so in the end after 5 emergency surgeries each with worse complications than the last (not the surgeon's fault..my body does not heal well)...I had to find a French surgeon who would help me quickly...in the end he colaborated with my Canadian surgeon and did some really good work. (the translating of my own procedure pre-op was really weird!)....
I love my new surgeon here, he is great...but it took a while to find someone who I was able to have full confidence in and trust...it says a lot about his honesty and bedside manner that he won me over in 5 minutes.
Sharon
A little clarification...I didn't leave my colorectal surgeon...I moved to France and seeing him became a very expensive process although he has never charged me for a visit...I have to fly in for a check-up (about +5000miles) so it was not a monthly thing...when I started to have serious pouch complications and my First French surgeon gave up on me I found a 2nd one (colorectal) who appently was not the most pouch-friendly kinda guy...the surgery was a collosal failure (I could not intubate my k pouch without causing a major hemmorage and could only doing it laying flat on the floor...he considered that 'unimportant details'...I could not lay on the floor and intubate at work so I had to stop working)...so in the end after 5 emergency surgeries each with worse complications than the last (not the surgeon's fault..my body does not heal well)...I had to find a French surgeon who would help me quickly...in the end he colaborated with my Canadian surgeon and did some really good work. (the translating of my own procedure pre-op was really weird!)....
I love my new surgeon here, he is great...but it took a while to find someone who I was able to have full confidence in and trust...it says a lot about his honesty and bedside manner that he won me over in 5 minutes.
Sharon
My original surgery for j-pouch was done in 1986 by a general surgeon and in 2007 the same general surgeon removed my j-pouch(thanks to c-diff) and placed an end ileostomy. Had lots of problems but mainly because I was so ill going into the surgery. My GI told me that if he needed any surgery including a heart-lung transplant he would let this particular GS do his surgery. Have not had good feelings from the 2 CR surgeons I have met with so I will stick with my GS for any more surgeries needed (hopefully NEVER).
you know, the more I ask around, the more I'm finding "specialized" surgeries having been done by general surgeons. Example- my nephew had to have half a lobe of one of his lungs removed at birth, due to a congenital defect in that lung. I just found out it was done by a general surgeon, not a thoracic surgeon! And this was at Childrens Hospital in Boston, where there are TONS of specialized surgeons. I realize that no surgery is "routine", but I feel fairly sure mine will be about as textbook as it can get- I'm currently not flaring, not on pred, don't have any any active abscesses, have never had colorectal surgery before.... I still haven't made a final decision & won't be able to until I meet with the general surgeon- I've met with the colorectal surgeon 2x now. And I really like the guy! I have lots of wuestions for the general surgeon, all relating to his personal techniques & experience. Thanks for the answers everyone- they help, really shed light on this!