J Pouch Surgery for Crohn's Colitis

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mbetter27

Hello Everyone,

I am new to the site and I need some help and advice. I am a 25 year old male who has been diagnosed with Crohn's Colitis (crohn's disease in which is confined to my colon). I have been sick for the last couple of years now and medications have lost their effectiveness (Remicade, Humira, Cymisa). A colonoscopy back in December '12 revealed that I had a stricture in my sigmoid colon in which needed surgical attention. My surgeon couldn't do a resection due to the severity of the inflammation in my colon. We opted to go with a temporary ileostomy while not removing any intestine. Our goal was to heal the colon through the diversion of the ileostomy. I had my second colonoscopy yesterday and my colon is still severely inflammed and has ruled out any sort of resection. I am now facing total colectomy with end ileostomy or J Pouch surgery.

I live in Ohio and my local surgeon will not perform the J pouch procedure on me. However, I visited the Cleveland Clinic and received the J Pouch surgery as an option due to my diagnosis of Crohn's Colitis. I am in need of some good advice and past experiences with anyone who has received the J Pouch surgery with Crohn's disease or colitis. I am truly grateful for any advice and/or help that I receive as I have a very big decision ahead of me. Thank you for your time and responses; I greatly do appreciate it!

All the very best,
Mitch

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Jan DollarModerator, RN, retired

There is a higher risk of pouch failure with a Crohn's diagnosis, even if it is confined to the colon. That said, if you are willing to assume that risk, then the j-pouch can be a good option. The problem is that there is no way of knowing if the Crohn's will return to the small bowel after the colon is removed. If you have rectal sparing, it is also possible to have an ileorectal anastomosis.

The Cleveland Clinic chooses their candidates for j-pouch very carefully, so it is not as though they don't have criteria for you to meet. For example, you'd have to be free of perianal Crohn's and any small bowel involvement. Other surgeons just are unwilling to take any chances, so are more strict with their guidelines.

I prefer the individual approach, so if you feel motivated to do it, you can't be in better hands than CC!

Jan

6/25/131:03 PM

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PluotMember

There is a paper that was put out by CC recently that followed up with I believe 3000 j-pouch patients who had it for UC, Crohn's colitis, FAP, and cancer. You can see that although the risks of complications are a bit higher for Crohn's colitis and the long term satisfaction rates are a bit lower, if you meet CC's criteria for a j-pouch for a Crohn's patient and you're OK with the %s quoted, then you should go ahead.

Found it: http://www.ncbi.nlm.nih.gov/pubmed/23299522

quote:
A total of 32
patients had a preoperative diagnosis of Crohn’s disease, with the remainder being diagnosed incidentally (postoperative histopathology
of proctectomy specimen) or at follow-up. Subset analysis revealed
that of these 32 patients, the only difference in perioperative morbidity or long-term outcome to date has been an increased incidence of
small bowel obstruction (34.38% vs 17.77%, P = 0.027). P

6/25/134:22 PM

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beckysmomMember

Hi. My daughter's surgeon in NY says that many surgeons will not do the surgery on crohns patients, but he will considering each patient individually.

It sounds like if you can go to CC, then it is your choice, at least you have an option, although sometimes that makes the decision more difficult. Hopefully someone with that experience will answer you.

I hope for the best for you whatever you decide.

6/25/139:28 PM

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