Hi there. I've been lurking here for a few months and have found information here to be invaluable. Thank you so much for this resource and to all of the contributors.
Back in January of this year, I had a perforated colon, most likely as a result of a diverticulosis episode. Long story short, I had an emergency colectomy. There is still a tiny smidge of my sigmoid colon remaining, and my rectum is intact. It was emergency life-saving surgery, and I'm thankful to be here. I have an end ileostomy. I have adapted to life as best I can with the ileostomy and found products and a routine that seem to work for me. I know for some having an ileostomy is a wonderful life improvement - I have so much respect and admiration. For me, the whole scenario was unexpected, frightening, and is still pretty surreal. If I had/have to have the ileostomy for the rest of my life, I'd/I'll certainly adapt, stay strong, and seek help when needed. That being said, at this point, I am a candidate for a reversal.
I am discussing a reversal with a couple of colorectal surgeons in my area - both with 2 decades of experience. As my rectum is still there, and assuming there are no issues seen with my rectum:
- Surgeon #1 would perform an ileorectal anastomosis (IRA) - that is where my small intestine gets hooked straight up to my rectum
- Surgeon #2 would perform a similar procedure. HOWEVER, he would add a small j-pouch with the end of my small intestine, affixed to the top of my rectum - so as to assist in holding stool - this procedure is called an ileal pouch rectal anastomosis (IPRA). I can't seem to find much information on the procedure with the pouch on top of the rectum (IPRA) - just these two links:
https://pubmed.ncbi.nlm.nih.gov/19318001/
https://journals.lww.com/journalacs/citation/2005/09001/long_term_functional_and_quality_of_life__qol_.27.aspx
So I would like to humbly ask the following questions:
1. Are there any reversed ostomates with a straight IRA in the group (small intestine hooked up to rectum)? And if so, any thoughts on the experience; and updates on where you are now with bowel movements and quality of life would be greatly appreciated!
2. Has anyone heard of and/or had the IPRA procedure?
FWIW, I am leaning towards the standard straight IRA, as it seems there would be fewer features that could eventually fail - at least that's what my gut says (pun intended).
Thank you so much!
Best,
Colin
Hi, I have an ileorectal anastomosis. That connection was formed during my colectomy and I had a loop ileostomy while the new connection healed. Day before reversal surgery they did a test to make sure the new connection did not have any leaks. How many inches of rectum you have will make a difference in the success of the surgery. My surgeon at Cleveland Clinic said that to do a J-pouch for me would be malpractice. Because I don't have a J-pouch I will never have issues like pouchitis. The tissue of the rectum is different than the tissue of the small intestine.
I'm curious why the one surgeon wants to make a pouch if your rectum is ok. I don't know if you feel like this is necessary but you could have a virtual consult with a surgeon at Cleveland Clinic to get a 2nd or 3rd opinion in your case (they are the best when it comes to these type of surgeries, they outrank Mayo in this particular area of medicine/surgery). I did pelvic floor therapy in between surgeries and after the reversal which I would recommend to anyone having these surgeries. I'm a woman and have had 2 babies so my anatomy comes with different challenges than a guy. I've done really well with the reversal but I made sure I could go back to an ileostomy if ever needed. So I keep in the back of my mind it will be ok if I ever have issues with my IRA and need to have an end ileostomy formed. A former surgeon on here helped me understand why the rectum can do what a J-pouch cannot. Happy to answer any questions I can. I haven't had any of the issues a lot of people have with the reversals. I really think in part at least the success has a lot to do with my surgeon and also being proactive about pelvic floor therapy.
I did have complications after the surgery (ileus). I've never had incontinence issues like a decent amount of people seem to have (again pelvic floor therapy- cannot stress that one enough and I was walking at least a mile a day to prepare my body for the reversal). Some people can know when they eat in x amount of time they will need to use the bathroom. I haven't been able to time mine like that. I am flying more when traveling vs road trips because on a plane there is a bathroom whereas with road trips sometimes rest areas are few and far between. I don't eat much when I'm traveling (driving) and stick more to water, smoothies, protein shakes (I'm tired of protein shakes at the moment). I'm only 9 months out from the reversal but I was doing handstands/backflips/and somersaults in the water with my kids this week.
-Jodie
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Thank you Jodie! This is very insightful. I'm happy to hear about your progress and good luck thus far.
Oyyy...an ileus - that happened to me when I had my emergency colectomy + end ileostomy. I still have PTSD flashbacks of the NG tube...ugh. I'm praying that doesn't happen again.
As for the pouch on top of the rectum, from what I understand this is a known procedure, but it just seems to me as though the addition of the pouch is more complex, and may not provide that much (if any) added benefit.
I did seek out a third opinion from a colorectal surgeon who is a friend of a friend - who confirmed there's not really much if any added benefit with the addition of the pouch above the rectum. Thank you for the Cleveland Clinic suggestion - I may reach out to them for a fourth opinion.
I will certainly start in on the pelvic floor suggestion.
Thank you sooooo much. It's great to hear from an actual person who has been through the procedure.
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Without inflammatory bowel disease, an ileo-rectosigmoid anastomosis should work fine without creating a reservoir. Commonly, an end-to-side anastomosis is done. Stools should be more liquid and frequent. J-pouches are not usually done for your medical situation and are associated with a lot of additional problems.
Colin, I don't know if visuals help you at all and/or if you've seen this before while discussing options with the different surgeons. I'm a visual learner so this helped me understand a little better how things would look/work. John (gentlejohn) who responded on this post was very helpful to me in understanding my new internal connection as well.
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My Ostomy Journey: Ryan | Hollister
Thank you Jodie and John! Yes - I met with my preferred surgeon on Friday and he explained this exact end-to-side connection! The other surgeon very clearly called this 'geometry' a 'j-pouch' - it's even in the written/assessment pre-op plan PDF I have!: "I described performing a J-pouch." I think it was just a terminology mix-up on his end, but enough to not make me feel 100% confident with that particular surgeon.
Thanks again!