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Reply to "34 y/o j pouch failing! Surgical options?"

A J-pouch really doesn’t use up very much small bowel, and I don’t think a new pouch would change your hydration very much. I also don’t think the CA risk is very high, because there’s so little rectal cuff. The risk definitely is isn’t zero, but that alone wouldn’t push me to pouch removal. OTOH your frequency and urgency sounds quite unpleasant, kind of like UC, and well worth fixing.

The first question is whether you’ve exhausted your medical treatment options. Some folks here with chronic pouchitis have had excellent results switching from antibiotics to one of the biologic agents, like Humira or Cimzia. Have you tried any of those, or at least discussed them with your doctor? Has C. Diff been tested for and ruled out? That could easily be misunderstood as antibiotic resistance, and if your antibiotic is Cipro the C. DIff just loves to colonize a gut with Cipro in it. Finally, have you tried high-dose probiotics? I get a lot of help from a maximum dose of VSL #3 DS (4 packets/day).

It can indeed be hard to remove a pouch, because it attaches to what’s next to it, but a skilled surgeon who’s done a bunch of pouch removals should’t have a problem. I honestly don’t know if a new pouch would have the same problems. I think of replacement pouches as great fixes for structural problems, but not necessarily for pouchitis. Your doctor may have better information. A K-pouch or BCIR might have a better chance of success in your case.

Good luck!

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