Yes, 07kr5 is correct. If it was a 2-step procedure you'd skip the end ileo and go straight to having a j-pouch with loop ileo. But if the patient is very ill, malnourished and/or on steroids, most surgeons prefer to do a 3-step procedure to give the patient more time to recover. Removing a colon and creating an end ileo is fairly straightforward and doesn't take very long - my first surgery only took an hour. (On the other hand my reversal took 3 hours and I didn't even have a j-pouch done! No complications either, it was just intrinisically a longer, more difficult, surgery.)My question is, if I was going about it as a jpouch then the stoma they would make would be the "temporary end ileostomy" so if it's temporary how would I be able to stop there and avoid surgeries further?
A 'temporary' end stoma is exactly the same as a 'permanent' end stoma. A loop stoma is actually physically different to the end stoma. It's hard to explain in words, but an end stoma stops at the stomach, whereas a loop stoma continues onto the colon or the j-pouch. A picture shows it better:/images.discovertherapies.com/article_images/images/000/000/045/max/loop.jpg?1493684511
Loop stomas are larger than end ones and have two
openings instead of one: the top
opening is for stool and the lower
opening is for mucus/gas. Temporary loop stomas are used to divert the stool away from an anastomosis (i.e. the surgicial join between two bits of bowel) in order to give it time to heal. I have heard of people having loop stomas for years, but usually they only last for a few weeks or months before being reversed. That's probably because loop stomas in general don't work as well as end ones do: they are harder to manage and more likely to cause leaks.
If a person is going to have a permanent ileostomy, or wants to leave the option
open to make it permanent, then an end stoma is preferable to a loop one. How was your recovery from the first procedure, pain wise, complications, etc.
At first it was really easy. The surgeon had done a good job and I had zero surgical complications. I was up and about
, and had a decent appetite, by day 2. Unfortunately something really stupid happened, which in retrospect made things a million times worse than they should have been. On the second night the needle in my back for epidural pain relief worked its way out and I ended up in agony for several hours, because thanks to sheer incompetence and bureaucracy nobody could or would get me any pain relief. Me and my parents complained bitterly to the hospital pharmacist the next day and he put me on oxycodone.
Well I'm from the UK so I hadn't even heard of oxycodone, as naive as that might sound. When I left hospital, my GP took over the prescribing of oxycodone. I had no idea what a high dose I was on (nor, I'm guessing, did my GP). Long story short, I got addicted. At some point I belated realised this and undertook my own taper. The whole process was a nightmare from start to finish. While the acute symptoms were much better after 4-5 days, I was still left with horribly sensitive/itchy/crawly skin, depression and fatigue for a very long time afterwards. I also had prednisolone to get off, another drug my body had become dependent on because I was on it so much before surgery.
So, most of my woes that first year after surgery were compounded by difficult and emotional drug withdrawals, not from any physical complications from the surgery itself. My advice for pain relief after surgery would be to take morphine or oxycodone for a few days only
and then transition onto something like Tramadol, and then wean off that as soon as you can.
Just to add to something 07kr5 said about
the rectum. You can have that removed during the first surgery, but if you are very ill and/or on steroids your surgeon may wish to delay it - mine did. Apparently rectum removal is a much longer and more delicate procedure than colon removal is. The main problem of keeping the rectum in is that it's liable to develop UC or even diversion colitis. You can't pass stool anymore, but unfortunately you can still pass mucus and blood. And it's a cancer risk as well. You should definitely have a talk with your surgeon about
the pros and cons of proctocolectomy surgery (i.e. surgery where both the colon and rectum are removed).