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Reply to "2 step or 3 step?"

Dr Remzi, whose specialty is pouch redo for failed pouches,  does three step for fresh new pouches when he makes them. He recommends a six month wait between the first and second in order for the mesentery to lengthen. Apparently, if the small intestine does not reach to the anus with a good margin to construct the pouch, it is major cause of complications. It can cause tension at the anal anastomosis. A 6 month wait between steps 1 and 2 allows the mesentery to lengthen. If you do two step, you cannot wait 6 months between steps 1 and 2, because they will be combined into one step. Better keep things slow and get a pouch without complications.

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