Mucosectomy/Pouch Advancement & Impotence

I can't really point to any articles in particular, but I think that the primary risk lies with the original surgery during the rectal dissection, in particular. Certainly, anytime you are having surgery in the general area, there is risk of impotence. Usually, it is temporary, due to swelling from the trauma, but rarely, the nerve damage can be permanent.

With a mucosectomy or pouch advancement after your original surgery, the pelvic cavity is not entered to any great degree, and these are typically done transanally, so less risk. Good questions to go over with your surgeon if you are considering the surgery.

The bigger risk is incontinence, due to damage to those nerves from the stretching of the anal canal and sphincters, along with traumatizing the delicate area at the dentate line (the transition between the anal canal and the rectum, where the nerves of continence are contained).

Jan

Thanks for your response, Jan. Good to know that it's relatively different from the original surgery. I'm not considering that surgery at this point but want to be aware of all potential eventualities.

On another note, if Asacol wasn't effective when taken orally for UC, does that mean that Canasa suppositories for cuffitis probably won't work either?

Common question, but the answer is no. Virtually everyone here who had colectomy for UC, failed medical management, and the mesalamine drugs are a first line treatment.

For whatever reason, what didn't work on the colon still usually works on the rectal cuff, thankfully.

Jan

Haha good point! Duh! I should have realized that Asacol would have failed for everyone who's now experiencing cuffitis.

Jon,

I see you are in Boston.

I am too. I had a j pouch with a mucosectomy recently. My doctor is one of the best in the field. I believe he did some pioneering work with mucosectomies. I'm happy to give you his name or talk more if interested. As for your specific question, at least in my case, no problems.

DEAR JEFF P.

Are you having any problems due to mucosectomy?

My concern is this: The step I of the two step J Pouch surgey was performed on 20th Sept 2012. A loop ileostomy was constructed. From 10th Oct. onwards, I started noticing blood in the stool that I was passing through rectum on a regular basis. My doctor concluded that it was cuffitis. He postponed my final (Takedown) surgery and adviced Hydrocortisone enema and mesalamine suppositories. I got relief from suppositories.

Now his plan is to do transanal mucosectomy to remove the rectal cuff and hand sew it to the dentate line. What do you think shall I expect? Feeling a little apprehensive.Kindly do give your opinion/suggestion based on your experience

Cksind,

It sounds like your having the same surgery I did, although mine was done in the first step. I'm doing well, but there is a greater risk of incontinence from what I've read with a mucosectomy. It makes sense since the lining is removed (weaker seal) and nerves could be damages.

That being said, I believe it relieves cuffitis concerns, assuming all the mucosal lining is removed. An important factor is the skill and experience of the surgeon. Some scrape away the mucosal lining (possibly leaving some intact), while my surgeon removes it intact.

As for impotence, what Jan said is in line with what I've heard, although my surgeon pointed out that a pouch or mucosectomy is less likely to cause damage than a complete removal of the area and a permanent ileostomy.

Kindly let me know who was your Doctor. I'll request my surgeon to seek his expert advise. Kindly give me his contact number for the same reason. Mucosectomy has not yet been performed. Iam living with ileostomy but have no problems at all. I take mesalamine suppositories on alternate days.

I retread your post. My doctor I'd exactly what you mentioned. Mucosectomy and hand sewing to the dentate line.

His name is Dr. James Becker. He practices at Massachusetts General Hospital (Mass General) and Newton-Wellesley Hospital, both in the Boston area.

I've heard that a Mucosectomy alone after you've been using your j-pouch might not be enough to keep cuffitis away as it is impossible to scrape all off and they can regenerate.

A pouch advancement gets rid of all of the old rectum tissue right? It might cause incontinence too. Does this Boston doctor do this surgery?

I thought the same thing about the Canasa and Asacol. I am having chronic Canasa and think I am finally getting a grip on it but it's taken me 18 months since it was diagnosed and I don't know how long I had it before then. I waited a year before having my first scope and there it was. If you can get a mucosectomy done before the j-pouch is attached to the rectal cuff I think it would be worth doing - in hind sight. I'm not so sure about having a pouch advancement after all is attached. I use canasa plus anucort for break through times - when it gets worse and I can tell from the pain.

Good questions, I wish I'd asked about cuffitis during my surgeries.

My doctor doesn't scrape off the issue. He somehow cuts it all out in a cylinder, so it all comes out. I asked about scraping and tissue remaining and he said he didnt do it that way, so it isn't an issue.

I'll defer to other experts as to whether it can be done with an existing pouch.

That sounds like the way to go.