Alaskanwombat, you need to talk to a different surgeon. It is still common to leave in the rectal cuff during surgery, because it’s easier to perform and has a lower risk of incontinence. If the cuff becomes problematic, though, as yours has, the cuff can be removed in what is called “pouch advancement surgery.” This is usually done with a mucosectomy. There is some risk of incontinence, and the hand-sewn procedure is technically difficult, so I would choose a very experienced surgeon if at all possible. And as Bill V says, even if you choose a through-the-belly exit for your ileum there are alternatives to an external bag.