Advancing jpouch w ukcers in distal pouch?

Um,yes you should be optimistic. Mine was badly ulcerated. I guess they must have made advancements in the surgery as I found it harder than the original and was in the hospital for a week. It took 3 months before I could sit. That was 15 years ago and I was only like the 15 one my surgeon did. R u using Milsom?

He is my original surgeon and just had a consult w him. I'm getting sso from Dr Remzi as saw him a year ago. He will not do surgery without diverting ostomy. I'm very nervous about this surgery and the possibility if infection without a diverting ostomy. This really is my last attempt at salvaging this pouch. I trust My surgeon, but honestly have had nothing but problems from day one of my takedown three years ago. I was very sick after takedown with a severe ilieus and I'm not sure I received the proper attention those three days after takedown before I somewhat recovered and just do not want a repeat episode. I was curled in a ball for two days after taken down before X-ray and did not see surgeon until third day after students tried to nose tube me unsuccessfully on day two. I have nightmares of revisiting my takedown experience. Could be why he wants to avoid the temp ostomy if possible but never mentioned it.

I would not do the ostomy. Why mess with additional surgery and ostomy problems. I still had mine when it was done. Milsom is a great surgeon and my situation was a lot worse than yours. He saved my pouch but not to scare u, I still suffer from pouch and cuff inflammation. I would trust him and hopefully it will work out great for you.

If it were me, I would consider the diverting ostomy. Not for infection control, but pain control. I have heard that the pain is considerable and if you do not have to also deal with toileting, it might make it more comfortable during recovery.

Still, it is a judgement call. Perhaps you can discuss this issue with your surgeon prior to the surgery?

Jan

Allykat, I have read your posts and that is on resson I am concerned also. My luck eill be i still will have pouchitis even after this surgery. Thank you for your comments.

Jan, I have asked my surgeon that question and his comment was we would worry about the ostomy after if issues with infection. He indicated my back end would be sore but Dr. Remzi 's response was I would be very grateful for a diverting ostomy due to the pain factor of this surgery. Different responses always complicates things .

Some surgeons are just more sensitive to little things like pain and functionality than others. The others are more concerned with the technical aspects.

I would think it would largely depend on your own personal tolerances. In your mind, what would be more tolerable? The issues associated with an ostomy and the related additional surgery considerations or significant anal pain and sensitivity? There are arguments for each approach.

Personally, I think this should be your choice of which is the lesser "evil." Still, you cannot force a surgeon to perform a surgery he does not want to do, any more than he can force you to have a surgery.

Jan

I haven't consulted with a surgeon but as you know thought about it in the past. In my opinion I'd go for the path of least pain and I hated my ostomy.

The thought of acidic waste pouring over a surgical wound in the anus that has a zillion nerves sounds like a nightmare to me! I'd go for the bag while I was healing.

Since my surgeries I am pain adverse. I got gas the last time I had a dental procedure and I've never done that before. No more Tough lady here, give me pain relief!

I see it from your point of view and feel for you going though all of this. It's a difficult surgery any way you look at it.

Waiting on Dr. Remzi's take after he reviews my never ending pouchoscopy reports from last two years. Will post for others.

Interestingly enough since starting back on augmentin and using anucort once a day for last few days, and really clearing out canal after emptying pouch, I really feel 100 times better. I realize that I was never able to fully clear out the cuff and lower pouch as much as I need to due to some narrowing at connection. My husband is reviewing Biget recommendation tomorrow for purchase.

I may very well still need surgery but at least my pain level has gone down as well as my pouch activity. I could easy survive like this if it were to last. Thank you SO much for advice and comments posted here!

https://www.youtube.com/watch?v=uzsq2OpOihE

Graphic U-Tube presentation by Dr. Remzi on J-pouch revision surgeries. Note that he discusses hand sewn procedures and how he does this part of the procedure himself and why. He does not show this part of the procedure. This presentation doesn't include exactly what we are discussing in your case jeane but I think it is marvelous.

This video was great. Thank you!!!!!

https://www.youtube.com/watch?v=XfnUomzjvfs

This is really graphic but at the end it shows how an original surgery - hand sewn muscosecomy procedure is performed through the anus with a diverting ileo.

Ykes