High grade dysplasia rectal cuff recommendations

Are they suggesting pouch advancement surgery or J-pouch removal? If J-pouch removal, are you thinking of an end ileostomy or a K pouch/BCIR?

10 months is a crazy wait for an appointment. Since you probably shouldn't wait anywhere near that long, perhaps your GI could intervene to try to get you an earlier appointment. You could also call the surgeon's office every day or three to inquire about cancellations. If you're consistently nice on the phone they'll start to remember you, and might call you first when something opens up.

My doctor has reached out to the surgeon directly so I’m hoping that should move it upA. But with the news and since the change in 6 weeks really don’t want to wait long. My doctor just said it needs to be taken out meaning the high grade. I am leaving all options on table but I had a horrible time with my loop stoma before my take down. So am really looking into K pouch but not sure if UPenn uses the option that often.

It’s important to find a surgeon with plenty of experience in the procedure you’re having. If no one at Penn has that experience then it’s best to look at other places to find the right person. You’ll only have the surgery once, but you’ll live with it for a long time. Perhaps a trip to the Big Apple?

Appointment scheduled with the chief of colon rectal surgeon at Penn in two weeks. Spoke to doctor and apparently looking at either a procedure where they take tissue out at a deep level and pouch remains but most likely going to be removal of pouch.

I’m glad you got a more timely appointment! In pouch advancement surgery the entire rectal cuff is removed, at least in theory, and the pouch is hand-sewn to the anal canal. They may be concerned about getting every bit of rectal tissue, though, and pouch advancement surgery is technically difficult. It’s more commonly done for bad cuffitis. If I were considering it I’d probably go to Dr. Remzi at NYU for the procedure. I hope your appointment goes well!

I have read about Dr. Remzi I’ll be calling today to try and be seen thanks for the advice.

Dr Kiran at Columbia also for a second opinion. He and Dr Remzi of the same caliber reputation but Remzi does not do the K-Pouch. Kiran performs them regularly. I scheduled consults with both of them (and a third surgeon) before proceeding with my surgery last year.  Now with virtual appointments it is very easy to get multiple opinions and an approach that you are comfortable with.

good luck!

I have an appointment with Dr. Remzi but not til April 4th my gi doctor thought that may be too far out and something needs to be done sooner. Have an appointment with doctor Rolando Rolandelli mid March. I thoguht Remzi did Kpouch?

I think you've got time to find the best surgeon.  I went 3 months from high grade dysplasia diagnosis to surgery.  After 40 yrs of colitis it wasn't a shock, but I felt the only thing I actually had control over was finding the right surgeon. I scheduled three consultations before deciding which surgeon to use.  

I got in to see Dr. Kiran at Columbia  - virtually - very quickly after having waited two months plus to see Dr Remzi, and deciding his open abdominal surgery approach was not for me.   After my own excellent surgical experience with Dr. Kiran I learned he has lots of fans on this site. As does Dr. Remzi.

True K-pouch surgeons are few and far between.  Kiran and  Remzi were among the Cleveland group that performed K pouch, but I had the impression that it was not a specialty of Dr. Remzi after they all left Cleveland. Not sure if I read it here or heard it elsewhere.  It could be I'm wrong about it and that Remzi still regularly does them.  His office would be able to tell you if so and with what frequency.

It is a specialty of Dr. Kiran for sure.