Surgery or Humira / methotrexate

Pouch advancement surgery with mucosectomy and a hand-sewn anastomosis can be very helpful when cuffitis can't be controlled adequately with medication. I'd offer two basic suggestions: 1) try the medication first. You can always stop it if it's unhelpful or has unacceptable side effects. 2) A hand-sewn anastomosis requires a very skilled hand for good results. It's easy to screw up, and then you're done. How many hand-sewn procedures has your surgeon done? Given what I've read here, I'd travel to New York and have Dr. Remzi perform this procedure if I needed it.

Good luck!

I am with Scott on this, unless your surgeon is quite certain that pouch advancement is in your best interests. From what you wrote, it seems more like a "Hail Mary" than an established next best option. The main reason I think you may be better off going with a biologic first is because you may still need it even with the surgery. 

One thing to keep in mind is that you'll need to give Humira and MTX three months before deciding to give up on it. I had good luck with Remicade and Imuran in controlling my chronic pouchitis. I must tell you that I went through Humira, Simponi, and Cimzia before Remicade, but that was just for my arthritis. The chronic pouchitis came later.

Jan

OK thanks Jan, and Scott, its great to have some support, I hadn't considered the pouch advancement procedure, so was surprised when he mentioned it, but not at all novel for him. He is a great surgeon. But I agree I should try other options first. I will postpone surgery for now..  

I believe that Jan and Scott are two of the more knowledgeable people on this forum and have found their advice to be very helpful so I would defer to them in their knowledge; however having said that I feel it necessary to chime in and say that I hope I never have to see Humira or Remicade again as I was on both of them (prior to Jpouch) and the side effects were absolutely intolerable  (at least for me). Nor did they help. Not a fan.......

OK thanks Veggiescott, that still helpful to know, I'm not a fan of taking medications either, I do it cautiously.. 

Would you then get rid of your ileostomy and use your j-pouch again? I am biased as I've had my j-pouch removed but think I would go for the surgical option.  If you still have the arthritis you can try biologics then. You might be able to use your j-pouch again with the surgery...that sounds great to me. 

As you can see, there is no one right answer. It all depends on your own particular case, what meds you've tried in the past, and what risks you are willing to assume.

Jan

Yes indeed Jan, Thanks Marie for your suggestions also - yes its not an easy decision. They have both have pros and cons. 

Agree would try the meds first! Humira turned things around for me and saved me losing pouch, now take Imuran with it...best of luck with your decision