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I am new on this site... even if I had a JPouch for 22 years. I am now at a stage where I have to choose between a redo and an ileostomy. I have bleeding problems (that causes severe anaemia), my Jpouch is too ditaled and probably twisted, difficulties to evacuate etc.

This website is a very usefull source of informations but when I read comments, it seems to me that many peoples are more or less happy with their Jpouch. And I feel the same too because I had to pass through some tough periods although I always had in mind that at least I did not have to deal with a bag.

Is my perception correct? Do most people have to deal with repetitive problems (as it is for me)or, I am wrong, and most are happy with their Jpouch? Does it exist statistics about succes rate of Jpouch? And about redo? Deciding between redo or a permanent ileostomy rises this question: Isn't too risky to pass through the redo surgery to get a new Jpouch wich I am not sure at all of the result. For the moment, I feel that the risks related to the surgery (urinary and sexual desorders, etc.) are too important and probabilities of a good quality of life with the Jpouch not high enough.

But, on the other hand, I hate the idea of having an external bag (I already had one for 1 year)

I needed to express myself on this despite my poor english. If any ones have information about the points that I rised, I will appreciate to read them.

Merci!

Rich M

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I suppose it all depends on your perspective. I would think that most people do pretty well on average, with the occasional bout of pouchitis or finicky belly stuff. But, for the most part, we do not deal with serious emptying problems, constant pouchitis, etc. Plus, one person may not pay much attention to some inconvenient symptoms, while another might think they are earth shattering and intolerable.

It is uncommon that things get so out of hand that redo or ileostomy is considered (10-20% depending on which study you read). This is what they consider a failed pouch.

You are in a particularly difficult situation, with no great solutions. You basically have three choices:

1. Keep what you have. Probably not a good choice since you are asking these questions.

2. Opt for a pouch redo and deal with the uncertainty of success. Depending on who does the surgery, success rate can be very high and complications low. This is particularly true for structural defects that probably will not recur. This is a different story if Crohn's was suspected.

3. Opt for an ileostomy or continent ileostomy (Kock pouch or BCIR). While a standard end ileostomy is a pretty easy surgery without much complication risk, that is only if you leave your pouch in place. If you are opting for pouch removal, ALL the risks you are worried about with the redo are still there. If you opt for the continent ileostomy, there are added risks. Still, this may be your best choice. It all depends on which risks you find acceptable.

No option will be perfect or come with any guarantees.

I would ask your surgeon what his complication rate is for each option and how you specifically stand in regard to those. If he does not do continent ileostomy, consider getting a second opinion, perhaps in Toronto. They have some very experienced GI surgeons there.

Jan Smiler

P.S. Your English is quite good!
Jan Dollar

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