Second J-Pouch Failed

I recall your posting about the k pouch in August and my responses to it.  I had my j pouch removed, my bottom sewn shut and a BCIR constructed in one operation and all went well. This way, I had only one hospital stay and one recovery period and was able to resume my normal activities sooner. I am puzzled that your surgeon wants to do it in two separate operations.  Has he given any reasons for not doing it all at the same time?   Has he also expressed an opinion why you have had persistent fistulas and abscesses at the anastomosis and why nothing more can be done to correct this problem?  If your j pouch itself is in good shape, it is possible that it could be converted to either a k pouch or BCIR.  You may want to get a second opinion from a surgeon who has done many of these procedures.

Please feel free to send me a PM if you have other questions or would like further insight about my experiences.

My son has had the same issues. Has any one discussed biological plug. I think it might be close to expermental, i know in NY it has not been done often. Cleveland clinic should know about them. Jeff has had an abscess and fistulia. Drains have been put in, he went back to an ostomy in less than a year.  In january they put him back on the pouch and the same thing happened again. The problem was his leak was behind the pouch where it could not easily be scene. Its been a total nightmare. Seven weeks ago the doctors in Interventional Radiology did this plug. We were originally told it had a 20% success rate. He played it down. They had only done this proceedure about 12-14 times but the actual success was about 60%. Much better odds. I hate to say this out loud but it just may be working. Before you go through a second pouch removal, consider something like this. I forget the ppharmacutical company that makes the plug but baker pharma comes to mind. The doctors did this as a last ditch effort before giving my son a permenant illostomy and pouch removal. Good luck to you. 

Nomoremeds posted:

Hi All:

I am currently scheduled to have my second j-pouch removed later this month, and I just wanted to see if anyone here has any insight on this situation

I had my pouch redone at Cleveland Clinic in March of 2015 due to a persistent leak/sinus. Now the second pouch has the same type of problems (fistulas and abscesses at the anastomosis). I currently have a diverting loop ileostomy (never had a take-down) and have been told by my surgeon (who recently left Cleveland Clinic) that I need to have an end ileostomy and that he will not "re-do" a redone pouch that has these types of problems at the anastomosis. He also said that there is no point in leaving the anal muscles that give control intact because another j-pouch would never be a possibility. 

While I have asked about a k-pouch, I have been told that I need to have the end ileo first and then do the k-pouch (if I want to go that route) in a second open surgery. 

Does anyone have any insight into benefits and/or drawbacks to leaving in the anal muscles after the pouch has been removed?

Also, for those who've gone from a j-pouch to to a k-pouch, was it done all in one surgery? Has anyone had to do it in two steps?

Any insight would be appreciated. Much thanks. 

who was your surgeon that redid your second pouch?  and how long after your second pouch was done did you start having issues?  I had leaks and sinus with my first pouch that were due to the ecoli infection I had from surgery and it almost killed me and kept me in hospital for 10 weeks. I had mine redone by Remzi last October and reconnected this past March. Had a MRI last month just to check things and so far still good

My re-do pouch was performed by Dr. Ashburn. She has offered a k-pouch, but suggested that I should have the pouch excision first. She said I have enough small bowel that loosing  another pouch should not be an issue if I were to go for the k-pouch down the road. Right now, I just need to be done with this mess and move on. I'm not thrilled with having a bag, but I can learn to live with it. 

There is no real explanation for why I kept developing fistulas. It could be crohn's related, or it could just be bad luck. My problems developed immediately after surgery, and Ive been assured there is nothing more that can be done.

When I had my J pouch removed I left the anus intact. I have had no issues, they do scope it every 2 years which is no big deal. I didnt want the potential complications from the butt wound, healing and so forth.  I just wanted the minimum sugery and to move forward. The end ileo has worked well for me. Now if you do have chrohns that may be a different matter as I believe it is possible to have crohns in the anal area. Good luck