Straight up (no pouch)

Naples.. you no longer have a rectum with a jpouch.

Yeah, jeane has it right. The small intestine can be connected directly to the rectum. This is called ileorectal anastomosis, or IRA surgery. Your rectum was removed when the j-pouch was created, so there is nothing left to connect the small intestine to. As was said on another thread already, if your pouch was removed and the small intestine were attached directly to your anus, it would be like having an ostomy coming out of your bottom -- constant output with no control. No surgeon in the world would do that to a patient.

IRA is almost never performed for UC anymore. It is sometimes used for Crohn's and cancer or other diagnoses where the colon must be removed (e.g. severe diverticulosis).

It is called ileorectal anastomosis. And, Jeane is right, you need a rectum for this.

Before the j-pouch was developed they did do an ileoanal anastomosis without a j-pouch reservoir, but the results were fairly disasterous, with terrible urgency and incontinence.

Jan

Jan - is there any literature about that from when it was being tried? Just curious. Everything I can find says that "ileoanal anastomosis" is just "another name" for IPAA.

I know people with IRAs and they will say it isn't that much different than having a Jpouch when the compare notes to one another. Everyone is going to be different and maybe not have pouchitis or have it and eat some things you might not be able to.

I can't eat cooked veggies with my digestive system but I have friends with a BCIR that even eat bowls of corn.

ok thanks for the replies..I guess if I choose surgery it would be reconstruct another pouch...I believe my chronic pouchitis was caused from eating sushi (raw fish) because i was fine for years until i started eating sushi..my drs assistant told me sushi was ok to eat..she gave the wrong advice.

Liz,

Here is one citing, to get you started:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1353186/

Jan

I don't think sushi is associated with pouch problems. It sounds like a coincidence to me.

Of course, sushi that is not carefully chosen and preared can be a source of food poisoning or parasitic infection, and THOSE can definitely affect pouch function. My first bout of pouchitis was due to food poisoning (but not from sushi).

I would expect thatif you were susceptible, sooner or later something would trigger the pouchitis.

Jan

Jan, the journal article you furnished a link to brings back personal memories to me. I was one of the patients who participated in that study. Dr. Robert Beart performed a straight ileoanal anastomosis on me in 1981, when the procedure was new, and I experienced significant frequency and incontinence problems after the temporary ileostomy was taken down. At that time, the doctors believed that a pouch would develop on its own if I could squeeze down with my anal sphincter when I felt urgency to defecate. When this did not work, they sent me a supply of Foley catheters and instructed me to “blow up the balloon” at the end of the catheter with hopes that it would expand my “pouch”. This was not successful. I was then invited to return to Mayo to participate in the study.
In 1983, Dr. Beart suggested that I have a third surgery to create an S pouch (J pouch with an extra loop). This was done in one step and helped somewhat with the frequency problem. I continued to have higher than normal frequency for the 30 years I had the pouch, but learned to live with it, not wanting to go to the bag. Early this year, I had the BCIR procedure after my GI discovered dysplasia in my anal canal. I recovered well after the surgery and now have a better quality of life.
Naples, you may want to get another opinion from a doctor who specializes in problem pouches. There are others on this forum who have had positive experiences at Cleveland Clinic. Surgery involving removal of a J pouch is major and should be considered only if nonsurgical treatments are not successful.

what isBCIR PROCEDURE PLEASE?

Bill, thank you for sharing that history with us. Reading a journal article just isn't the same as hearing from someone who went through it. Bob Beart was my surgeon, too, but fortunately J-Pouches had been invented by then.

Rebecca, if you click on the little "Find" button you can search for posts on BCIR and read all about it.

BCIR- Barnett Continent Ileostomy Reservoir (similar to Kock pouch)

Jan

quote:

I had the BCIR procedure

Hi Bill, did you have your BCIR done in Florida or Cali?

Vanessa, my surgery was in Florida with Dr. Rehnke and he did an excellent job considering I was not an easy case. The care I received at Palms was top notch.

Bill