Do you need the rectal cuff for a functioning Jpouch? I have had my pouch for 18 years with minor issues of pouchitis/cuffitis. Recently during scope came back a small area of high grade dysplasia in rectal cuff. Surgeon is going to attempt to resection and reconnect pouch to a small amount of recital cuff. Through research and some Facebook groups I have heard you may not need a cuff at all. I was worried about incontinence. Any thoughts on the need for the cuff would be greatly appreciated.
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A rectal cuff isn’t needed, but it does make the procedure technically much easier, and there is a higher incidence of incontinence with the hand-sewn procedure with rectal cuff removal. That being said, if I were in your situation I’d make an appointment with Dr. Remzi at NYU to discuss a pouch advancement procedure to remove the entire rectal cuff and reattach the pouch. Most surgeons just don’t have enough experience with a hand-sewn anastomosis, but Remzi is the guy and Philadelphia just isn’t that far away. You are still in Philadelphia, right?
Yeah I am scheduled for surgery on April 4th to remove the high grade and if it ends up being more than just high grade the surgeon will be creating a Kpouch. Headed to Morristown Medical Center in North Jersey with Dr. Rolandelli.
I have an appointment with Dr. Kiran at columbi this Thursday and Dr. Remzi next Monday. So will be able to discuss with them prior to my surgery date.
I consulted with both Remzi and a Kiran before my surgery. K-Pouch has been my back-up plan, which is why, among other reasons, I elected to have Dr. Kiran perform my J-Pouch surgery and would use him again should the pouch fail to meet expectations. Because I had high grade dysplasia the cuff was removed in the first stage procedure which has given me peace of mind but probably added to the challenges of adjusting these past 9 months since stage 2.
For either K-pouch, or advancement, I'd use whichever surgeon (and medical center) has the most experience as both are technically demanding procedures.
Good luck with the consultations. Let us know whether their recommendations differ and what you decide.
Hi I just wanna chime in to say that Dr Remzi removed my entire rectal cuff and did the hand sewn anastomosis. I got my life back (had many problems before)