Colon Removal--Advice Please

Hello All:

I am a 71 year old male diagnosed with UC, and possibly Crohns, doctors are not sure. I have an ostomy. Doctors removed part of my descending colon about 6 months ago. Medications such as Entyvio and other biologics make me feel better but are not reducing inflammation throughout the colon. Additionally during the many colonoscopy and biopsies one biopsy identified dysplasia.

Doctors now recommend removing most of colon connecting ileum to the where the rectum and sigmoid colon meet. This means I will have my rectum in tact and possibly a very short portion of my colon, depending on what surgeon finds when he operates. The surgeon says there is no need for a J-Pouch.

First I would like to know if anyone in the forum has experienced this type of procedure. And second would like to know what I can expect in the way of bowel movements and other problems after the surgery. I am very concerned about what my lifestyle will be like after the surgery.

 I was hoping I could find others on this forum who could tell me their experience about such a surgery and its aftermath.

Thank you,
Nick

Original Post

I have never heard of the procedure being done without a J Pouch being created out of the ileum. The rest of what you described is what all of us had with J Pouch surgery. The only thing missing is the J Pouch. So where exactly does your doctor propose that the stool be stored? The whole point of a J Pouch is to act as a surrogate colon. Based on what you describe there would be no storage facility and if there isn’t, I assume you would have a ton of BMs as food simply passes through with no “truckstop” anywhere from your mouth to rectum. Doesn’t make sense and sounds like we may be missing something here.

CTBarrister:

Thank you for your quick reply.  I will certainly follow up with my surgeon about the question you have, but as I understand my surgery, a part of my colom and my rectum will still be in place and the ileum will be attached to what is left of my colon with the rectum in tact.  So the storage of bowel will be in the rectum.

Nick

This is called an ileo-rectal anastomosis. If I recall correctly they were more common before J-pouches were developed. It’s a strange procedure to suggest for IBD, I think, whether you have UC or Crohn’s colitis, since it leaves behind the entire rectum, which can readily develop inflammatory symptoms. I think the results may not be as good as J-pouch results, on average, but I haven’t double-checked that. My reading of the literature on indeterminate IBD is that a J-pouch is the procedure of choice, and that’s what I chose 16 years ago. If your surgeon lacks the necessary experience and skills, it’s best to consult a more experienced surgeon. If your surgeon has a good reason for suggesting an IRA instead of a J-pouch, he ought to tell you what it is.

Having a rectum would in theory remove  most of the problems I have with a jpouch, notibly more control and the ability to expel gas. I actually requested an IRA when I had my operation. Doc said he would do it, but then countered with what Scott said, that basically inflammation and cancer could develop in the rectum, and ideal he would remove as much as possible.  When I asked how much he said I was thinking, so basically all of it, as tight into the cuff as possible.  If I had the IRA I would need 6 monthly scopes but jpouch is much less frequent.

 

The point he made was that I was 'young' and the pouch would ideally be a one stop operation that would last decades.  Without wanting to be in any way disrespectful, that is possibly less of a concern for yourself and the relative simplicity of the operation should lead to a quicker recovery and better outcome in the shorter term.

But definately worth seeing if your doctor says that our of he has another reason.

The IRA procedure is done rather commonly for people with Crohns where the disease does not involve rectal area. There is always the possibility that Crohns may show up in the rectum but more often than not it doesn't. So these can be very successful in Crohns. 

I have never heard of it being done for people with UC, though as with most things it likely has been done. I looked into a partial removal of the colon as I had limited disease and it was well controlled, this after I was diagnosed with cancer. I had, had UC for 25 years and I found there is very little documented info and no studies as to success that I came across. Partial removal of the colon in UC, except in emergencies, just isn't done very often.

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