Most of the rectum is removed in J-pouch construction. Typically 1-2 cm of rectum nearest the anus are left as an attachment point. When necessary there is a hand-sewn procedure that removes even more rectum, but you wouldn't generally make that your first choice (it carries a higher risk of incontinence). The hand-sewn procedure requires a *very* skilled and experienced surgeon.

Hello.
That is where my problem was. Right at the rectum. At first they said no j pouch. The ulcers were too close and there would be nothing left to attach to. So I let it go and suffered for years until I talked to the surgeon herself. She said it was a possibility but that it was unlikely that UC would attack what was left so I went and did it. I have about 2 cm left. My ulcers were right at the end.... They showed me the scope pics everytime.
A year plus since surgery.... No problem with UC but a host of others.
I won't go into that. It's an individual thing. Everyone ends up different. Some have no problems. I find that hard to believe.... But I guess it could happen. Not with my luck though. No fault of the surgeon or pouch for that matter.
Richard.
P. S. My gastro Dr said it was not a possibility to get the Pouch. I talked to the surgeon as said above. I made the decision... I wanted the Pouch and I figured I had to try it first and if it didn't work I would bag it. But pouch first!

As noted previously a small segment of rectal cuff is left in. You should be aware that there are some studies from Cleveland Clinic that show that there is a cancer risk with the retained rectal cuff, particularly if any colonoscopy you had to date showed dysplasia. You and your surgeon should be discussing this issue before any decision on surgery is made. Did your latest colonoscopy show dysplasia, and if so, where?

I should note that I had dysplasia in my colon in 1991, J Pouch surgery in 1992 and I have been scoped and biopsied every year since with no cancer or dysplasia having been detected in the rectal cuff. The Cleveland Clinic study showed a small % of cases where cancer developed in the rectal cuff, mostly in persons with long term inflammation and/or a finding of dysplasia.

Scott- 1-2cm doesn't seem like much. I know I have superficial ulcers in my sigmoid and a part of my rectum, but I'm not sure how far down my rectum is infected. I hope it isn't too much. I know that whenever i don't have a flare, I'm able to "hold it in", so maybe it isnt too much. But I have had an abscess there before. Thanks for the response!

Mysticcobra- I think talking to my surgeon before the actual procedure is a good idea. I would like to make it clear that I would absolutely prefer the k-pouch. Thanks for the tip!

Ctbarrister- I dont think I have dysplasia. There isnt anything in the report that indicates that. But getting scoped is a good idea regardless, to screen for cancer. Thanks for the response!

My UC was limited to my rectum, I had a stubborn ulcer that would not heal. I had jpouch surgery with a mucosectomy and I've been healthy and happy for 14 years. If you are worried about continued cuff problems, talk to your surgeon about a mucosectomy if you are considering a jpouch. If you're going for a permanent ostomy, talk to your surgeon about his/her style of removing the entire anal area and sewing it closed. Some close the area, others don't.

Sue

Hello,
I had my surgery in March 2007. Because my rectum was also diseased due to the UC, very little was left of the rectum. The j-pouch was hand stitched carefully (from what I was told) and took over six months to fully heal before I had the takedown.