I am strongly leaning towards the one step surgery because I do not want to deal with the bag. I know this is uncommon and the surgery is usually 2 or 3 step but I've heard stories of the 1 step. Is it so uncommon that most doctors will deny it or is it uncommon because people just don't opt for it? Any advice is appreciated. I love u guys thanks.
Original Post
One-steps aren't very common but if you're a candidate for one I'd definitely say go for it. But also be aware that no surgeon can guarantee a one-step. The assessment about whether to proceed with it happens once they've opened you up. You probably should run from any doctor who absolutely guarantees that s/he can do your surgery in one step.

The advantage to a one-step (other than no ileostomy) is that adhesion formation may be lessened. One of the places some adhesions form is at the stoma site so this would be eliminated. It doesn't mean that you definitely won't have adhesions but at least you wouldn't have them there. (And many people don't form adhesions so it's not something to be overly concerned about.)

I also think that the fewer times one is under anesthesia the better. Every hospital stay has risks and the fewer hospital stays the fewer the risks.

And I'm just a big chicken about surgery and hospitals so I would personally do anything to avoid them. I had a 3-step because I was so sick. So you'll want to have surgery being a healthy as possible. I've actually never heard of a surgeon performing a 1-step in an emergency situation (unless Thomas, Connie's son fits that bill).

Good luck with the decision-making process and welcome to the site.

kathy Big Grin
Depends on the surgeon, the hospital (teaching or not), the condition your body is in and how it is done...my surgeon over here is a laporoscopy expert and does a 1 step through lap with a great success rate...less complications, less adhesions, fewer infections etc...but he does not belong to the public health system and one has to go private to get that sort of service...look around, get refferals and talk to some of his patients.
Sharon
I have an appointment with my surgeon a week from tomorrow and I'm going
to ask if a one step surgery is a possibility also. I've been off prednisone
for quite a while and I'm going into surgery in good health (except for the
LGD). If it's an option I'm willing to give it a go.
I had my surgery done in 2 steps. We were planning on a 3 step surgery, but when the surgeon went in, decided to remove the illeostomy and connect me then. He said that I had some damage from my first emergency surgery. It has been a very painful healing process. I am 7wks out, and still in a lot of pain.
I had a 3 step and after my experience, I'm not sure how anyone can do a 1 or 2 step. I decided not to rush things and let my body heal and I think that's helped me have very few problems with my pouch. In this moment in time, I've extremely happy with it.
I have Gardners Syndrome. My Father had his surgery in 1983 and it was a three step process mainly because he is 6'3" and the surgeon was afraid it would leak if done in a one step process. In 1990 I had mine and was tattooed on both sides for a temp or permanent. I was glad to wake up to a one step process and have had better results with mine as far as being able to control bowels more. Maybe because I was so young(25) and determined. My brother had his first 3 months ago and is taller than my Father and therefore came out with a temp bag for the same reasons. Afraid it wouldn't hold up to the pressure while healing. He just had his reversal three days ago so not sure how his outcome will be. He is patiently waiting to pass something.
I was told I may be a good candidate for a one step procedure but during the surgery the doc decided otherwise and I ended up with a 2 step. I am 8 weeks post op from takedown and looking back I think the 2 step def. worked better for me. The bag really isn't so bad once you get the right appliance and you don't have skin breakdown. Mine made travel so much nicer, if I din't eat much I didn't have to stop to empty out the bag. It was very predictable for me. Now with my j-pouch I have very good mornings but by late afternoon I tend to start going alot. So I guess my pouch is getting pretty predictable also. I was lucky enough to have mine done lapriscopically and that was nice! Good luck on your surgery and keep us posted on how things go.
I had the one step done 13 years ago this month. It was a decision my surgeons made literally while I was on the table. I fully expected a bag and did not have one when I woke up. It was risky at the time b/c of possible infection, but I was very, very fortunate. I have had no problems with my pouch. I don't know if that helps, but I am sure they have come an incredibly long way toward the positive in 13 years. Good luck!
Yep, one step here.

Gastro wanted a 3 step
Surgeon wanted a 1 step.

They argued and argued and argued for 1 week and in the end left me to make the decision. Considering I had never even heard of colitis 2 weeks earlier or ever been in hospital. You can imagine I chose the one step.

Wouldn't change it for the world.
I know the BCIR is different than a jpouch but it's a one step. Granted we are hooked up to suction from our pouch for 19 days but makes me wonder why more jpouches can't be one in a one step. When I was considering the jpouch I was going to do the one step route. They told me it was up to me. I didn't have UC or was sick going into surgery though.
My surgeon wanted to perform a one step. Sounded good to me. My gastro doc said, "No!". He said I had been on Prednisone too long (three years) and that along with my age (61 at the time) I would have healing issues best addressed by having a two step procedure. My surgeon wasn't happy but I insisted on a two step. He gave me a fantastic stoma....long enough not to recede in the coming months. I ended up choosing to keep the temp. Ileostomy for a full year because I felt so great and, for me, it was so easy to manage. I was really frightened to have the takedown. Glad I waited. A year later I decided to go ahead with the takedown and my pouch was really healed. My takedown was a walk in the park! Now, ten years plus later, I'm still doing very well with no regrets whatsoever. Best wishes.
quote:
When I was considering the jpouch I was going to do the one step route.
Just to reiterate, you can opt for a 1-step but it's never a guarantee. A surgeon can't know for sure whether a 1-step is feasible until s/he's actually playing around inside you.

I think there are a number of reasons more 1-steps aren't performed with j-pouch surgery. One is that it takes more specialized training. Another is that the formation of a j-pouch is more complicated than the surgery for a continent ostomy. More small intestine is used sometimes with tall people things don't reach as far as they need to. Sometimes the reach just isn't possible so a j-pouch isn't possible. But sometimes a multi-step procedure can 'stretch' the small intestine to fit the new plumbing. (I think I'm explaining all this correctly.... Roll Eyes)

kathy Big Grin
Yes, Kathy, you are explaining it correctly. One of the big issues beyond the obvious general health and use of steroids, is the reach of the mesenteric blood supply. This is mostly an issue for men (narrow pelvis) and those with a long trunk (generally those who are tall). But, something that is unknown until surgery is underway. Doing it in two steps can allow for some stretching and/or healing of the surgical "tricks" to lengthen the mesentery. In rare cases, even with the "tricks" the j-pouch is not possible.

But, I wouldn't go so far as to say that the j-pouch is more complex than the continent ileostomy, which has its own set of challenges, one of which is the fact that few surgeons perform it.

Jan Smiler
I had a two step surgery that turned into a one step during the operation. We discussed how I would have the temp. ileostomy between surgeries, but once he was in there he went for it and I woke up bag free much to my surprise! I was pretty stoked.

I was happy with the way it turned out, now I just need to take better care of my pouch so it lasts!
I was so sick and had so many complications that the planned three-step ended up taking four. And I had one of the best surgeons on the US.

If you've got a surgeon who says you're a good candidate, then what's the benefit to a planned two-step? None that I can think of. But as said, run from a surgeon who guarantees a one-step since the final assessment will happen when you're under anesthesia already. Sometimes someone can seem a good candidate, but then seeing the organs up close can eliminate it from being a good option.
Another reason why my one step j-pouch surgery was possible was because I had an end ileostomy for a year, so my body was fully healed and healthy when I went in for the j-pouch. Plus I'm sure the pyoderma gangrenosum skin ulcers I had all around my stoma site lead him to keeping everything inside me if possible, lol.
I had a one-step 20 years ago because high-grade dysplasia was found during a routine colonoscopy. My surgeon said that I was a good candidate for a one-step because I hadn't been on prednisone (UC)in many years, was a good weight, and was in relatively good health.

He did warn me that he wouldn't know for sure whether I would have a one-step until he took a look inside. I'm 5'10" so he wasn't sure if the mesentery artery would be long enough to connect to the pouch.

My pouch has worked very well all these years with the exception of a bout of pouchitis from taking NSAIDS for migraines.

My one regret at the time of surgery is that I didn't walk enough, causing my gut to be slow to wake up. The stagnation caused an infection to set in. Once I was passed this, everything was fine.

Rose

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