I will try to answer your questions.
1. I don't really know where this idea comes from the the pouch only lasts a certain amount of time. I was never told my pouch would have an "expiry date." Your pouch, once constructed, is part of your body and like anything else, it should last a lifetime. I plan to keep mine for as long as I'm around.
I would have never done this surgery if I had any inkling or had been led to believe that the pouch would just stop functioning or deteriorate in 5, 10, 20 years etc. Now, that is not to say that was oblivious to the potential for problems. I certainly knew there would be risks, but I went into it on the hope that my quality of life would improve for the long term - which it most certainly has. I love my pouch even with the slight hiccups I've had and I plan to keep it for life.
2. Although a good functioning pouch should last you a lifetime, a smaller portion of pouch patients will have problems with their pouch, ultimately leading to pouch failure and or removal. Problems that may lead to pouch failure can include, but are not limited to: chronic, medication resistant pouchitis; a Crohn's diagnosis after pouch formation; mechanical problems with the pouch; nerve damage to the sphincter (usually during surgery) leading to chronic incontinence; severe recurring strictures and/or other motility issues; and chronic severe cuffitis (inflammation of the rectal cuff). However, it should also be noted that many people with the above problems opt to keep their pouch and ultimately find some balance between managing the symptoms and having good day to day functioning. That is to say, a Crohn's diagnosis or chronic pouchitis does not automatically mean you will lose the pouch. Sometimes pouch removal is more of a personal decision--what is tolerable for one person may not be tolerable for another. Only you can know what you can/cannot handle.
3. I'm not sure I entirely understand this question. I'm guessing you mean pouchitis. It's not possible to get pouchitis with an end ileo or loop ileo as there is no internal reservoir for either, but if you have a BCIR or Koch pouch (two forms of continent ileostomy) then you can develop pouchitis in the reservoir just as you would with a j-pouch.
4. I have not had a pouch advancement so I cannot advise, but I believe this is usually done when there is some problem with the rectal cuff. At any rate most people do not end up requiring a pouch advancement.
5. Yes. Although they have a tendency to recur in some cases, strictures can be successfully treated, managed or eliminated with dilation. Sometimes this can be done in one doctor's visit or several; you can also self-dilate at home under the guidance of your physician. Occasionally surgery is required to dilate a stricture but generally non-surgical methods are tried first.
Hope that helps!
