Dr. Remzi: Pouch procedures and why pouches fail

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. 

 

Thank you for postjng. My son has a tiny leak that is causing all kinds of problems. Now that Dr Remzi is in NY we may be consulting!

I heard he is at NYU? Is that correct? 

Thanks for sharing, a great video 

Yes.  Ally, you are in NY right?  

 

Yes, I'm over at Cornel I was sorry to see Dr Bosworth leave. 

Whats going on with your son?

Oh the saga is endless. We r at cornell too. Jeffrey had surgery in Jan for 2nd rakedown. Then another fistulia and abscess.  Has a drain in his butt. When we return from Japan they are foing to try a biological plug to stop the leak. Next step will be Remzi   Who is your surgeon over there?  And how r u doing?

Dr Milsom is my surgeon. Has been for 16 years. Can't get rid of me,lol

the Entyvio allowed me to reconnect last Dec. 

Are they talking Remicade? 

Can you develop a leak after years and years of a healthy functioning pouch? 

My surgeon is very skilled, but I would be so much better if he listened to this and took it to heart. Dr. Remzi is so great.

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

Thank you for the youtube link �� I always wondered if Dr. Remzi was Turkish because his last name sounds so...but I was too lazy to check it online. Now I am sure �� He has quite an unusual first name though.

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