Curious if it is possible to do the two surgeries needed for a j-pouch at once

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New Member

Date Joined Jan 2008
Total Posts : 11
   Posted 1/10/2008 6:03 PM (GMT -6)   
I've been doing some research on my whole "situation" and read something that mentioned doing both in one surgery. My doctor said I'd have one and wait 6-8 weeks (it seems like this is a relatively short period of time between the two...) and then have the other to create the j-pouch. I'm just curious if anyone has heard of anybody doing both as one surgery. I'd love that, but I'd imagine it hasn't been done for a reason ;) lol. Thanks for the help!

Regular Member

Date Joined Jul 2007
Total Posts : 280
   Posted 1/10/2008 8:46 PM (GMT -6)   
All doctors are different, mine does the j-pouch in 3 steps. 1-remove the colon have temporary end ileostomy 2-create the j-pouch have a temporary loop ileostomy 3-close the loop ileostomy and begin using pouch. Some remove the colon and form the pouch at one time and second surgery will connect the ileostomy and begin using pouch.

I think there are a lot of factors when considering 1-2-3 steps
How sick you are when you have the surgery
Making sure there are no leaks with the pouch (it is after all sutured/stapled to the rectal floor) and giving time for the pouch to heal before using will ensure less leaking of stool between the pouch and the rectal floor (this will usually result in pouchitis/cuffitis)
How well the small intestines can pull without too much tension
If there are abscess' in the rectum/where your UC is located

My 2nd step is scheduled for this Monday and we are hoping that it can all be done in this step. My doctor says that I stand a good chance because I am tall and thin, but he said it will really depend on how well the intestines can pull and be attached.

You also want to make sure that you have a good surgeon, mine performs about 60 j-pouch surgeries a year and is credited by the CCFA search for colo-rectal surgeons

I've gotten a lot of information on regarding the steps of the surgeries, it's a good place to check out

Good luck to you
CD diagnosed in 1991
Only one serious flare up in 1998 and again in July 2007
Total colectomy August 2007 now saying UC
J-pouch surgery to be scheduled in 08

New Member

Date Joined Jan 2008
Total Posts : 11
   Posted 1/10/2008 10:58 PM (GMT -6)   
Huh, I thought I already replied to this... Well anyway, I haven't really talked to my doc about the 1step yet, but I think it's possible. I'm young (18) and relatively healthy (a bit overweight, but I'm working on that now) so I think it would be possible. I've googled more about things relating to 1-step j-pouches and they seem to just a bit more common than I thought (though not very much).

Regular Member

Date Joined Jan 2008
Total Posts : 29
   Posted 1/11/2008 5:48 PM (GMT -6)   
hi i'm a new member my sister is due to have the operation soon i go along with her on all her visits to the hospital, my sister will have the two step op, this means the removal of the colon and the j-pouch made in one surgery one of the reasons this was recommended to her was bcoz she is still young so therefore she has a good chance.

Regular Member

Date Joined Nov 2007
Total Posts : 98
   Posted 1/12/2008 10:37 AM (GMT -6)   
When I originally consulted my surgeon he was going to do my surgery in the 3 steps that tbraz mentioned above, but by the time I was ready to do it, he was able to do it in 2 steps. The reasons had to do with how sick I was and the meds I was on - particularly the dose of prednisone. My dose had come down considerably and he said as long as I was on no more than (I can't remember if it was 10 or 20mg/day), I could keep the surgery to 2 steps. I had the TC in October of '07 and he removed the colon and most of the rectum, created the j-pouch, and gave me a loop ileostomy. I had a pouchagram in December and everything's healing just fine so I'm supposed to schedule the takedown sometime in the next few months and start using the j-pouch. Twelve weeks between the 1st and 2nd surgery. I just haven't scheduled it yet.

New Member

Date Joined Jan 2008
Total Posts : 11
   Posted 1/12/2008 5:24 PM (GMT -6)   
Elisha - I think you misunderstand a 1-step versus a 2-step. A 1-step surgery involves what you described - taking the colon out, making the jpouch, and hooking the jpouch to the rectum ALL in one surgery, eliminating the need for even a temporary bag. A two step just splits it up - I believe they do make the jpouch on the first surgery, but wait a while to hook it up to let it heal, meaning a bag would be used until the takedown. I've heard of the three steps method, and thats for really sick people.

Fortunately for me, I am young and healthy, as far as intestines/colon go (need to lose a few pounds though :P ), so I think there is a good chance of a 1-step for me. The thing is, though, you can't be 100% sure you will have a 1-step. The surgeon wont know if he/she can do it until they open the person up and evaluate several qualities of your colon/intestine. So make sure you and your sister are prepared for the possibility that a 2-step will be needed. Good luck to your sister :)

Heh, in these couple days I've done a lot more research and know more about the whole 1step 2step thing than I did - though if I got something wrong, PLEASE correct me! I don't want to give anyone false information! :D
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