why do they leave the cuff?

They try to leave a 'neck' on the pouch, a couple of inches attached to the sphincter to allow for, from what I understand, better continence...so that the pouch does not empty strait out...when it works, it works well but it can retain the UC or crohns disease and cause as much pain and problems as before the pouch creation...Cuffitis.
Some people have a mucousectomy or a stripping of the linning of the cuff...Which can work too. No idea of the statistics on how many pouchers have cuff problems but I am sure that someone has them somewhere.
Hope that things improve for you
Sharon

So pouch advancement can lead to incontinence?

The standard cuff is a centimeter or two, not a few inches (that is the cuff length that leads to very serious issues). The reason it is left is because the ATZ (anal transition zone) between the anus and rectum is where the nerves of fecal continence are contained. It is quite easy to damage these nerves, even in the most skilled hands. So, unless you have a low rectal cancer or high grade dysplasia, they try to not risk your pouch success in that way. And yes, chronic fecal incontinence leads to pouch failure.

Pouch advancement is considered a salvage procedure, not a first choice if you are having problems. But, worth trying when all conservative measures fail if you want to try to save your pouch.

Jan

Thanks Jan, my cuff measures under 2 cm. I'm due to see my GI at Cleveland clinic on November 13 for a conservative approach first.

quote:

The standard cuff is a centimeter or two, not a few inches (that is the cuff length that leads to very serious issues).

It is interesting that you mention this because my GI doctor, after my most recent scope in June 2014, complimented the work of my surgeon in leaving a very short amount of cuff. My GI doctor trained at Cleveland Clinic and Dr. Shen is his mentor, so he has seen many, many J pouches and does not shoot from the hip with such opinions.

I have never had Cuffitis, to my knowledge, despite consuming vast amounts of antibiotics over the last 20 years. I have essentially been on antibiotics nonstop since 1995. They did see some inflammation in the Cuff in June 2014, and biopsied it, but they came back negative.

My GI told me if a cancer ever develops, the retained rectal cuff is where it will develop- because I had dysplasia in my colon, I am in the risk category. The Cleveland Clinic did some study on this and they did find some cancers developed in the rectal cuff of J Pouch patients. However he told me it was mostly people that had severe pouchitis for many years.

So get this...my first surgeon left me with a 10 cm cuff..

Not surprisingly, I have had terrible problems since.

Hopefully Dr Remzi will fix me all up in a couple months.

10cm? That's not a cuff. That's half a rectum!

Jan

exactly Jan... Wish I had done more research before allowing that butcher - I mean surgeon - near me..

Yikes jpouchmike....sorry that happened to you.