Reversal Surgery Question from Mark

[Lynne]

I'm re-posting this question from Mark in Indiana as it's own topic.
Lynne

I was diagnosed with colon cancer last October and had a colectomy in November. Unfortunately, I had complications with my original surgery and had to have a follow-up procedure that resulted in an ileostomy. I had my entire colon removed with about 4" of my rectum remaining. My doctor is strongly suggesting that I have reversal surgery this summer, and I would love to get rid of the bag, but I'm worried about incontinence and constantly feeling I "have to go." I'd like to talk to someone who has had the reversal surgery if possible. I don't know if this is the right site or not.

Any help you can give me would be greatly appreciated.

Mark in Indiana

[LindaAukett UOAA Advocacy]

Hi Mark,

I don't have personal experience (though I've lived with an ileostomy for many years), but I'm sure some others will chime in with theirs. I'll just point out some of the things that need to be taken into account.

The outcome will certainly depend on the type of surgery your doctor is talking about. Some general surgeons can do a colostomy or ileostomy competently, but still think they can just do a straight anastamosis of the small bowel to the rectum. Please, if that is what he or she is discussing, seek a second opinion.

Colon & rectal surgeons know better, that there needs to be some capacity built in through creation of a small pouch from the last part of the small bowel (a J-pouch or some other variation). That internal pouch provides a small storage chamber which cuts down greatly on the urgency you fear.

They also know that they have to test your muscles in that area to be sure you can be continent - that it would make no sense to do that surgery if the sphincter isn't strong enough. Now, it doesn't have to be Superman's sphincter - just normally capable of holding stool.

The fact that you had cancer in or near the area also needs to be part of the equation. Did you have radiation? Sometimes that can affect the ability of tissues in the area to heal properly.

Please stay tuned here - this is the very first day of the board -well, I guess now it's the second.

Linda

[SugaAngel4u]

Mark,

I too had colon cancer, an ileostomy and 7 yrs later I was able to have it reversed. I understand the concern about incontinence, but try not to worry too much about it. There are exercises to strengthen the muscles that help control bowel movements and prevent/reduce incontinence as well as medicines. Also, discuss a jpouch with your doctor. A jpouch would help reduce/prevent instances of incontinence more than a straight-pull thru. I have a straight-pull thru, with the use of exercises before the surgery and the use of medicines afterwards, I do not have to worry about incontinence. It's a common problem that can be dealt with and has many solutions. Hope everything goes well for you.

[SugaAngel4u]

Some general surgeons can do a colostomy or ileostomy competently, but still think they can just do a straight anastamosis of the small bowel to the rectum. Please, if that is what he or she is discussing, seek a second opinion.

Linda

like i said earlier, I have a straight pull-thru, or a straight anastamosis and I've known people who have had their colon removed and immediately had a straight pull-thru done all in one surgery without even having an ileostomy and everything couldn't be better for them. Its success really depends on the individual, just like in the case of every other procedure/surgery.

[barbie]

As I wrote in another post, I have an ileostomy...was not a candidate for a j-pouch due to age and very little rectal stump left.

For all I have read on the J-pouch site, I would opt for a Kock pouch over a J-pouch. The Kock pouch people seem happier with the results. Again, as I wrote in the previous post, I would trust my life to Dr. Victor Fazio of the Cleveland Clinic. He just has the best reputation in the field, (although there are other good doctors out there I have read from other posts.)

[Tracy]

Hi Mark,

I don't have personal experience (though I've lived with an ileostomy for many years), but I'm sure some others will chime in with theirs. I'll just point out some of the things that need to be taken into account.

The outcome will certainly depend on the type of surgery your doctor is talking about. Some general surgeons can do a colostomy or ileostomy competently, but still think they can just do a straight anastamosis of the small bowel to the rectum. Please, if that is what he or she is discussing, seek a second opinion.

Colon & rectal surgeons know better, that there needs to be some capacity built in through creation of a small pouch from the last part of the small bowel (a J-pouch or some other variation). That internal pouch provides a small storage chamber which cuts down greatly on the urgency you fear.

They also know that they have to test your muscles in that area to be sure you can be continent - that it would make no sense to do that surgery if the sphincter isn't strong enough. Now, it doesn't have to be Superman's sphincter - just normally capable of holding stool.

The fact that you had cancer in or near the area also needs to be part of the equation. Did you have radiation? Sometimes that can affect the ability of tissues in the area to heal properly.

Please stay tuned here - this is the very first day of the board -well, I guess now it's the second.

Linda

Linda,

I'm confused. The rectum is a storage organ so with a rectum, a jpouch is not formed correct? In the J pouch procedure, aka ileoanal anastomosis, the rectum is removed correct?

Tracy

[SugaAngel4u]

i had a straight pull through and i still have my rectum. i had a failed jpouch before.

[SugaAngel4u]

tracy, it should also be noted that i had colon cancer not colorectal cancer, which includes the rectum. so there wasnt any reason to remove my rectum.