Hey guys - I was all set for the Jpouch surgery but my latest colonscopy diagnosis changed from Ulcerative Colitis to probably Crohn's because of microscopic granulomas and microscopic terminal ileum involvement with microscopic granuloma so now I am re-considering surgical options. I am currently taking a biologic called Vedolizumab. Can you guys give me advice? I saw a surgeon at Cleveland Clinic and at Mayo Clinic and got the following advice:
(1) Cleveland Clinic surgeon said we can still do the Jpouch surgery even with confirmed Crohn's because I don't have any signs of disease in the upper GI and that my TI disease is microscopic. He said we would start with subtotal colectomy and that the rectum would heal after step 1 because stool isn't going through. He said I would need to continue meds before and after surgery to try to make sure disease doesn't reoccur.
(2) Mayo Clinic surgeon said that we can do surgery but it would be an ileorectal anasmosis if it is confirmed Crohn's after colon sent to pathology. I questioned how we can do ileorectal when my rectum is not spared and in such bad condition. He said, kinda like CC surgeon, that the disease in the rectum often becomes quiescent after stool doesn't go through and I would need to continue meds in between surgeries and after.
So, both surgeons seem to agree that the rectum will get better once still doesn't go through. This brings up a question that I forgot to ask and I might email them.
This is my question that I am pondering: What if I did a temporary colostomy to give the rectum and sigmoid time to heal since they are the only parts that have Gross disease (the rest of the colon is microscopic and responding to vedolizumab). The temporary colostomy could be diverted at the splenic fixture. As the surgeons say, this would allow the rectum and sigmoid to heal since no stool is going through. I would continue taking my vedolizumab medicine before and after the surgery. Then if and when the rectum and sigmoid heal up, I could reconnect and then see what happens. It is kinda similar to the mayo clinic surgeon's suggestion but better in that the colon is retained. What do you think of this? The advantages are I get time to gain health back with diversion, I continue taking vedolizumab to keep inflamation under control, rectum and sigmoid get chance to heal up with stool not passing through and vedolizuamb medicine plus enemas and other rectal meds, and I minimize loss of intestine which is important with Crohn's diagnosis.
Would greatly appreciate everyone's advice before I ask the surgeon about this!
(1) Cleveland Clinic surgeon said we can still do the Jpouch surgery even with confirmed Crohn's because I don't have any signs of disease in the upper GI and that my TI disease is microscopic. He said we would start with subtotal colectomy and that the rectum would heal after step 1 because stool isn't going through. He said I would need to continue meds before and after surgery to try to make sure disease doesn't reoccur.
(2) Mayo Clinic surgeon said that we can do surgery but it would be an ileorectal anasmosis if it is confirmed Crohn's after colon sent to pathology. I questioned how we can do ileorectal when my rectum is not spared and in such bad condition. He said, kinda like CC surgeon, that the disease in the rectum often becomes quiescent after stool doesn't go through and I would need to continue meds in between surgeries and after.
So, both surgeons seem to agree that the rectum will get better once still doesn't go through. This brings up a question that I forgot to ask and I might email them.
This is my question that I am pondering: What if I did a temporary colostomy to give the rectum and sigmoid time to heal since they are the only parts that have Gross disease (the rest of the colon is microscopic and responding to vedolizumab). The temporary colostomy could be diverted at the splenic fixture. As the surgeons say, this would allow the rectum and sigmoid to heal since no stool is going through. I would continue taking my vedolizumab medicine before and after the surgery. Then if and when the rectum and sigmoid heal up, I could reconnect and then see what happens. It is kinda similar to the mayo clinic surgeon's suggestion but better in that the colon is retained. What do you think of this? The advantages are I get time to gain health back with diversion, I continue taking vedolizumab to keep inflamation under control, rectum and sigmoid get chance to heal up with stool not passing through and vedolizuamb medicine plus enemas and other rectal meds, and I minimize loss of intestine which is important with Crohn's diagnosis.
Would greatly appreciate everyone's advice before I ask the surgeon about this!
