PDS, pouch advancement can be very effective in the right hands. It's normally done with a mucosectomy. It's a very delicate, hand-sewn surgery - if I needed it I think I'd get it done in Cleveland, or at least interrogate my surgeon about how many he has performed, how successful they have been, where he learned the procedure, and what rate of incontinence he's had. This is much more specialized than creating a stapled J-pouch.