2 vs. 3 surgeries for J-Pouch

I was NOT on prednisone at the time of my surgery and my surgeon was trained on doing the procedure in 2 steps laparoscopically for patients that were a candidate for two steps. I had the proctocolectomy and the j pouch created at the same time, then 3 months later the reversal of the ileo. It was a tough recovery from that I will say but it all went smoothly and in the end I was happy to only have two surgeries. The less surgery in my opinion, the better because it cuts down on scar tissue/adhesions forming which causes blockages. It also has to do with how your surgeon was trained and what they comfortable doing and of course being on prednisone weighs in on all this. I don't think there is a right or wrong way as long as the surgeon is highly skilled and has done tons of these procedures.

I had the 2 step open surgery, although when removed my colon was "dissolving" in my surgeon's hands.

I was on 60 mg Prednisone at the time. They will give you Prednisone by IV during and slowly wean you off after surgery. In my case I had some mild withdrawal symptoms consisting of constant dull headaches. Getting off the Prednisone was a good thing because it led me to have some osteopenia prematurely, in my left forearm.

I believe its more a matter of how your surgeon perceives your health pre-surgery as to whether the surgeon chooses 2 or 3step surgery. And yes, steroid usage is a component of that evaluation. For me, I was on massive steriods, including IV steroids for a week in the hospital, and very very ill with a UC flare. So my "emergency" surgery turned out to be a 3step surgery. I would always choose a more conservative approach and a more conservative surgeon if I was given a choice. 3step is definitely a more conservative approach than 2step as it allows your body to heal in between stages.

I went with a one stage procedure. I was on prednisone at the time, which had to be bumped up. The hospitalization lasted 10 days, and was quite miserable, but I was glad to get the whole thing over with. I think I'd make the same choice again, but it was a very long 10 days.

In my experience, don't even think of a 2 stage, especially if you are on prednisone. I had a 2 and should have been a 3. Because of this the surgeon cut a hole from my jpouch to my vagina and now 6 years later I am still having surgeries to fix it. The only way you could possibly have a 2 stage is if they take out your colon now and have you come back and create the jpouch and have it start working the same day. No way should you have your colon removed and a jpouch created the same day. And, if you went to Cleveland, which seems to be the top place for this surgery, they would do a 3 stage. Better safe than sorry.

Thanks for your input everyone!
Dawn - were you operated in New York?

I met 2 surgeons prior to my surgery. One said 3 surgeries and one said most likely 2 but no promises. Both are extremely reputable colo rectal surgeons so I knew I'd be fine with either surgeon. I went with the surgeon who said 2. I was on 30 mg of pred, had failed last few remicade infusions(it was in my system) and on azathioprine. I was also very sick and my weight was really low. Anyway fast forward he did it in 2 but I had complications and a very rough recovery on the first surgery. Knowing what I know now I'd still go for 2 even knowing how difficult everything was.

yes, I was operated in New York and Randi, you are lucky there was no real damage given the state of the tissue. The choice of 2 or 3 surgeries should not be up to the patient. The surgeon should scope the patient and see if it is safe to create the jpouch at the time.

I was given the choice of a 1- or 2-stage procedure. I selected the single stage because I was having the surgery about a thousand miles from home, and didn't want to do it twice. I was warned that I'd likely spend about the same amount of time in the hospital in either case, and indeed it took ten miserable days in the hospital to get my GI tract and the pouch functioning. I'm still glad I got it over with in fewer hospitalizations.

I had the 3 step surgeries and I waited 10 months between 1 and 2 so I was very healthy going into surgery #2. I believe because of this I've had minimal problems with my pouch and I'm very satisfied with it.

I feel that the fewer surgeries one has is way better. With each surgery there are risks. I also feel that a 1-step surgery can help alleviate adhesion/blockages at what would be the stoma site if one had more than 1 surgery. But of course, no good surgeon would ever guarantee one over another without getting a good look-see.

kathy

I had the one step procedure, but becuase I developed sepsis (which can be the case in any surgery) I then have to have 2 further sugeries, a temp-ileo and takedown. If I had to make the decision today, I would definately still go for the one step, because I can see that although it is a huge operation your new plumbing starts adapting from day one. If I hadn't had complications I would be 3 months further on now with my recovery. I am also getting obstructions around the ileostomy site which I wouldn't have if I had managed the one step.

It seems like there are good reasons to get a 2 or 3 step surgery. A 1 step procedure is just not an option in my case. I guess I will choose the surgeon that I feel most comfortable with taking into account his experience with the jpouch and whether I can afford him.

Once again, thank you for your inputs. I truly appreciate it.

Your plan makes sense to me. Choosing the right surgeon is very, very important.