Most J-pouch procedures are stapled with a 1-2 cm rectal cuff. The procedure is technically more straightforward, and tends to have better outcomes overall, but sometimes the IBD remains aggressive and the cuff becomes inflamed, which can be very troublesome. Cuffitis can sometimes be managed with medication, but sometimes pouch advancement surgery to remove the rectal cuff is necessary. OTOH most J-pouchers do not develop cuffitis.

Some J-pouch procedures are hand-sewn with little or no rectal cuff left. The procedure is technically difficult and easy to screw up. There is a higher rate of incontinence (of varying degrees) with this procedure, particularly if a mucosectomy is also performed. The risk of cuffitis is close to zero, though.

It might be instructive to ask the other surgeon if the procedure he’s planning is stapled or hand-sewn. If it’s stapled then (as far as I know) then there must be some rectal cuff to staple to, though he may take particular care to retain the minimum necessary cuff. My guess is that if you misjudge and chase that too far you could increase the risk of leaks, but that’s just a guess.

I have no rectal cuff with a very low stapled anastomosis. I had a bad UC flare in the rectal stump between stages 1 and 2/3 so my surgeon dissected away all the diseased mucosa. Still used a staple line. I would have had cuffitis from day 1 of he left any colonic tissue behind. And now no cancer risk. I have no incontinence issues. Lots of variations out there.

I have a rectal cuff. I have had cuffitis, but it was not a major issue, and I had very serious pancolitis six months prior and up to the day of surgery. Chronic pouchitis was my big bugaboo over time. While the notion of possible cuffitis is something to consider, it is more easily managed than nerve damage to the nerves of continence. If those nerves are permanently damaged, it leads to pouch failure. The nerves of continence are located in the ATZ (anal transition zone) which is the area between the rectum and the anal verge. As with most anatomy, there is variability of this zone. These nerves sense whether there is solid, liquid or gas above the anus.

If you have a low rectal cancer or high grade dysplasia, completely removing the cuff is likely mandatory, and worth the risk (in my opinion).

My point? It is not as simple a choice as it seems. Ask lots of questions of your surgeons and consider what risks you can live with. I had my surgery in 1995 and had many complications. But, I still have a functioning j-pouch and have never had any positive dysplasia or cancer in biopsies since my first diagnosis in 1972.

Jan

Sadly I do have cuffitis.  It’s painful and none of the suppositories are working and I have had since 2017.  I really wish I would have just went with the bag.  The urge push and pain are almost unbearable but I keep plugging away.  

I am not trying to tell you what to do but just what I go thru almost daily.  

I think what Jan and Scott said is very important to keep in mind and ask your surgeons.  I’d like to do what Pouch2021 had done.  I just keep praying something will work or it will go away.

Good Luck.  And keep us posted please.  

I have a small amount of rectal cuff, last scope I had the new doctor said she left such a small amount cancer is highly unlikely. I have pouchitis but as far as I'm aware the cuff has not had issues.  I was never asked whether I wanted it or not, it was just done, probably the standard.

Yeah I have my rectal cuff, under 2cm too. Typically: older school surgeons take out the rectal cuff and new surgeons typically do not, that is majority how it is but some are in the minority of it being opposite or depending on the situation.

SOmetimes "islands" of the rectal cuff can potentially grow back but not much, definitely important to get scoped every now and then, every 1-3 years.