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From YouTube, here is a presentation in late 2015 by Dr. Remzi on "Understanding Pouch Procedures and Why Pouches Fail".  Please be prepared it is graphic. It might help people who have problems and questions about the procedure. I'm sorry if this has already been posted. For new pouchers like me it provides a lot of information and diagrams. Graphic actual surgical shots, please be aware. I hope I've attached the link correctly.

 https://m.youtube.com/watch?v=CoZuQxY2yCI

 

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Thank you for posting.  Interesting points that I gleaned:

1.  Leaks, leaks, leaks -- no such thing as an acceptable leak.

2.  Surgeons not having enough experience.

3.  Crohn's disease being blamed for failed pouches.

While we all can't have Dr. Remzi do our pouches, I would hope that all colorectal surgeons considered taking the time to learn from Dr. Remzi -- even if it means taking off from their patients to go witness one of his surgeries.  Surgeons need to check their ego at the door, as he said.  I benefitted from a Dr. Remzi pouch redo. 

 

aka KNKLHEAD

Brewbirds, it is possible to develop a leak at any time. Howver, what is most likely is for the leak to occur at the time of surgery or during early weeks of initial healing. It may take years to develop into something diagnosable, because the leak is so tiny. But, in reality, it was always there. It was just not detectable. 

If you have unexplained symptoms that defy all imaging and other diagnostics, sometimes the culprit is an indolent leak/sinus tract that is only fully discovered by surgical exploration. We'd like to think that CT and MRI technology gives us perfect views inside the body, but they remain limited. You only wind up seeing what the contrast can get to (either by cavity flow or bloodstream). The rest is a black void that appears fine. It is only when things change to affect adjacent structures that it becomes more apparent.

Also, the skill and experience of the practitioner viewing the films can make a huge difference. The doctor that keeps looking despite negative results is the true puzzle solver.

Jan

Jan Dollar
Last edited by Jan Dollar

This was a very informative discussion.  Not only about leaks.  But also about who should and shouldn't be recommended for a pouch.  He said if a person can live with an ileo it should be that way.  I was one.  I should have went straight to it instead of two years of misery.  I know personally why he mentioned this because I went through it.  A pouch is not for all.  And people have to come to terms with it.  I went the hard way. 

Very very important discussion.  Hindsight.  

And damn.  I can see why it hurt so much after surgery.  That was hard to deal with along with having a first time ileo on me.  

My wife also watched it.  She found it very interesting and informative. 

I am just so glad there are people out there that would pretty well devote their lives to this.  Thank goodness for that. 

Richard 

Mysticobra
Last edited by Mysticobra

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