I had a one-step procedure, and aside from an uncomfortable post-op period I’m glad I got it over with. There is a higher rate of leaks with a one-step procedure. As far as other surgical issues, they are uncommon, and each one is a bit different, since the pouch is hand-made. If you’ve ruled out or fully treated pouchitis and SIBO and still have trouble then a visit back to your surgeon could potentially be helpful.