jared, my understanding is that you don't have to have it removed. This would be something to discuss with your surgeon. Many people simply opt to have it disconnected rather than removed. But, from what I have read, those who just have their pouches disconnected sometimes continue to have similar problems despite the bypass, including ongoing pouchitis and inflammation. I believe there are several people on this board who have had a disconnect rather than a removal and have had varying results. Perhaps they would like to share their experiences with you.