Question about incision for surgery

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Bennie
Veteran Member


Date Joined Nov 2006
Total Posts : 550
   Posted 5/24/2008 11:04 AM (GMT -6)   
We are getting closer and closer to agreeing that surgery will be the best thing for bratcat. I emailed the surgeon with lots more questions. He set up a phone appointment so we could discuss everything. This worked out great because it allowed bratcat, my husband, and myself to speak to him.
 
He does not do the surgery laproscopically. So my question is for anyone who has had the full torso type incision. What is the scarring like? Bratcat doesn't seem overly upset over it. I guess it is more me. And no, I am not vain. I just hate that my 17 year old daughter will have such a large scar. I guess the scar will fade a bit over time. The doctor did say, if she wanted, she could go to a plastic surgeon in the future.
 
Also, he said that he would do stage 2 (of 3) using the same incision. Does this create more scarring? Does it take longer to heal?
 
Any input on how this will affect a 17 year old girl is appreciated. Bratcat wears tankini bathing suits so that isn't an issue.
 
--Mom of bratcat (17 years old)--
Daughter bratcat was diagnosed with pancolitis October 2006
Current meds:
Asacol - 4 pills/3Xday, 2 tabs 6-mp/1.5 tabs 6-mp every other day, 35 mg prednisone, Remicade
 
11/14/06 - started prednisone; 1/28/07 - finished prednisone!
3/3/07 - began to taper off hydrocortisone sloowwly! Summer 2007 - slowly began tapering Rowasa. 9/07 -- flaring? Nightly Rowasa. 9/21/07 -- added hydrocortisone enemas. 9/30/07--added prednisone. 10/31--started 6-mp, stopped the enemas. Started lowering prednisone. 3/08-another flare!


suebear
Forum Moderator


Date Joined Feb 2006
Total Posts : 5690
   Posted 5/24/2008 12:13 PM (GMT -6)   

I had the traditional surgery and my incision is about 5" long and runs from below my navel to the top of my pubic region.  However, everyone's incision length is different and I think it's based on each person's unique physiology. 

Sue


dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free


Bennie
Veteran Member


Date Joined Nov 2006
Total Posts : 550
   Posted 5/24/2008 12:37 PM (GMT -6)   
Thanks Sue. I think the incision would be from above the belly button down to the pelvic bone.

--Mom of bratcat (17 years old)--
Daughter bratcat was diagnosed with pancolitis October 2006
Current meds:
Asacol - 4 pills/3Xday, 2 tabs 6-mp/1.5 tabs 6-mp every other day, 35 mg prednisone, Remicade
 
11/14/06 - started prednisone; 1/28/07 - finished prednisone!
3/3/07 - began to taper off hydrocortisone sloowwly! Summer 2007 - slowly began tapering Rowasa. 9/07 -- flaring? Nightly Rowasa. 9/21/07 -- added hydrocortisone enemas. 9/30/07--added prednisone. 10/31--started 6-mp, stopped the enemas. Started lowering prednisone. 3/08-another flare!


Charlotte Gilman
Regular Member


Date Joined May 2008
Total Posts : 100
   Posted 5/24/2008 5:18 PM (GMT -6)   
Bennie, I had UC myself for ten years until having step 1 of the J-pouch surgery (laparaoscopically) at the beginning of April.

I have been reading along here for the last few months, since it became clear that I would need surgery myself. But I was just motivated to register in order to say that I hope you guys will consider getting bratcat a surgical consult with someone who does do the surgery laparoscopically. I really cannot say enough about how big a difference it has made to me to be able to get back on my feet quickly--something that is much harder with open surgery. I walked a mile and a half on a treadmill at my hotel (I had already been checked out of the hospital) four days after the op. There is also lower risk for adhesions, which is one of the most problematic long-term complications of this operation (and responsible for 90% of cases of intestinal obstruction, something you and she will want to avoid if at all possible). And when there is postop ileus, it is typically shorter in people who had the surgery with the scope. The success rates of the surgery are otherwise the same.

It is amazing to me how few GIs seem to know that doing this surgery with a scope is the state of the art. My own GI, who is fantastic and who practices at a major university research center, did not believe that it was commonly done until I told her about it. My second opinion GI, who is also fantastic and practices in a somewhat smaller hospital, didn't know it either! If your insurance will cover someone who has experience with this procedure, please do consider looking into it. It is worth traveling for if you have to.

PS My incision is about 4" long, just under the pubic hairline, so it will be totally invisible once all of what they shaved for the surgery has grown back. I also have one small scar where my surgical drain was, and will have a scar of about an inch when the stoma is closed. This is pretty typical, from what I understand--here's a picture of someone else's that looks the way mine will:

http://www.flickr.com/photos/markandmegan/

Scroll to "healing 10 weeks post-takedown."

Post Edited (Charlotte Gilman) : 5/24/2008 5:24:54 PM (GMT-6)


Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 5/24/2008 7:04 PM (GMT -6)   

Bennie-I was not a candidate for lapro surgery but know many who have had theirs done that way.  The scaring is minimal which might be something to think about for bratcat...and on top of that, you get back to life quicker.  I did have my proctocolectomy done by open surgery and I have to say I have a rather long scar.  I'd say somewhere around 10" and two of them are above my pant line.

I am not sure where you are located, but you may want to look into the lapro surgery and if bratcat could even be a candidate for it.  I know sometimes the dr's say they aren't sure which way it will go until they're there, but sometimes they can say up front.


summerstorm
Veteran Member


Date Joined Aug 2006
Total Posts : 6571
   Posted 5/24/2008 7:51 PM (GMT -6)   
i had just regular surgery and my scar goes from about three inches above my belly button down past my hair line. It has started to fade, i didnt' put any of that stuff on it, like curad scar therapy or anything. I did notice though, that the area of the scar that is under the bandage, is much lighter, so i wonder if i were to leave a bandage over the rest if it would lighten it?

Booka
Regular Member


Date Joined May 2008
Total Posts : 60
   Posted 5/24/2008 9:26 PM (GMT -6)   

Hi Bennie-

My daughter had a open Sub-Colectomy and her scar goes from her navel to the pelvic bone...she also had an open gallbladder s/x done and her scars overlapped,but it looks great...only if you really hard can you see it...My daughters surgeon did a plastics closure...She is only 11 so both me and my husband were concerned about the scar...but even w/ it going over it twice it looks great!! She is having a Total Colectomy on 6/5/08 and it will be open,and they said they were going to use the same scar again,and again use a plastics closure...She had to have open s/x because of issues w/ her colon etc...They did try laporscope first but could not do it...We go to Boston Childrens Hospital...and we live in Tennessee...so ask your dr about the plastics closure...or like others have said get a second opinon...untill we found Boston Childrens we went to about 4 other drs...Hope this helps. You are in my prayers!!

Booka(krista)


Bennie
Veteran Member


Date Joined Nov 2006
Total Posts : 550
   Posted 5/25/2008 12:31 AM (GMT -6)   

The surgeon prefers not to do sub-total colectomy laproscopically. He does do other surgeries laproscopically so he is not against them completely. He did give us the name of another surgeon in case we wanted it done that way. He doesn't do plastic closure. He suggested a plastic surgeon in the future if she wanted.
Just when I think we have accepted surgery and we like the surgeon, now we have to think about whether or not it would be better to find a different surgeon.  As I said, bratcat seems less upset about the type of incision than me. I am going to call her ped. GI on Tuesday and ask him some questions.


--Mom of bratcat (17 years old)--
Daughter bratcat was diagnosed with pancolitis October 2006
Current meds:
Asacol - 4 pills/3Xday, 2 tabs 6-mp/1.5 tabs 6-mp every other day, 35 mg prednisone, Remicade
 
11/14/06 - started prednisone; 1/28/07 - finished prednisone!
3/3/07 - began to taper off hydrocortisone sloowwly! Summer 2007 - slowly began tapering Rowasa. 9/07 -- flaring? Nightly Rowasa. 9/21/07 -- added hydrocortisone enemas. 9/30/07--added prednisone. 10/31--started 6-mp, stopped the enemas. Started lowering prednisone. 3/08-another flare!


Charlotte Gilman
Regular Member


Date Joined May 2008
Total Posts : 100
   Posted 5/25/2008 9:51 AM (GMT -6)   
Hi Bennie,

I know thinking about this can be exhausting! Just to be clear, my choice for the laparoscopic procedure was not because of the cosmetic stuff--it was because of the higher risks associated with doing the procedure open. The cosmetic advantages are nice, but I'm in my mid-30s and I'm not going to be wearing any more "belly shirts" anyway!

It is a little harder to find surgeons who do total colectomy (which is what bratcat should be probably getting, even if it's step 1 of a 3-step j-pouch--a subtotal will leave in diseased colon) with a laparoscope, and no one can guarantee that any given procedure will definitely happen that way. But the experience of the surgeon makes an enormous difference in how likely they are to have to convert to an open surgery.

I also know that it's hard to think about continuing to look once you've found someone you're comfortable with. I talked to three surgeons before I had the operation--the first two were both very nice and were at a hospital that's two blocks from my house. But I didn't really know what I was looking for in a surgeon. You're unconscious for most of the time when they do their work, so how are we ever supposed to know whether or not they're good?

Finally my GI said: "What you want is the person who does that procedure over and over again every week. Hundreds a year." I ended up traveling more than 500 miles for that person. But my thinking was that this is the kind of surgery that needs to be done right the first time, and I wanted to have the best chance of that happening.

Good luck with it, whatever you choose!

suebear
Forum Moderator


Date Joined Feb 2006
Total Posts : 5690
   Posted 5/25/2008 1:22 PM (GMT -6)   

Personally, for this complex sugery, I would take the surgeon with the most jpouch experience over a surgeon who does it laprascopic.  Maybe they are one in the same in your case but for me I took the surgeon who had performed over 2000 procedures.  

Sue


dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free


summerstorm
Veteran Member


Date Joined Aug 2006
Total Posts : 6571
   Posted 5/25/2008 7:38 PM (GMT -6)   
yeah i say go for the one who has done more surgeries. that's very important, at least i think so. or maybe you could look at where they went to school and where they trained.
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