This topic is about finding an experienced medical team for a vaginal or total hysterectomy in a patient who has an ileostomy and no rectum. The person seeking advice is concerned about the complexity of the surgery due to their specific medical condition and is looking for guidance or referrals to surgeons who have successfully performed similar procedures.

Here are some helpful pieces of advice and insights:

1. Consider getting second or even third opinions from highly-rated medical centers. Places like the Mayo Clinic, Memorial Sloan Kettering, and Cleveland Clinic are known for handling complex gynecological cases and offer video consultations.

2. Opt for a large hospital and ensure that a multidisciplinary team is involved. It's beneficial to have both a gynecologic surgeon and an ostomy/colorectal surgeon working together. This team approach can help protect the stoma or, if necessary, re-site it and manage internal cavities.

3. An open abdominal approach, using the previous midline incision, is often recommended over laparoscopy. This is because the small bowel, which can be free-floating, might be at risk of perforation during laparoscopic procedures. It's also wise to have the abdomen pre-marked in case the stoma needs to be relocated.

4. Seek out a gynecologic oncologist or a GYN surgeon who regularly performs bowel resections or works with ostomies. This expertise can reduce the need for a second surgeon if complications arise.

5. Remember that surgeons are there to work for you. Some people have switched their initially assigned surgeon after researching their credentials and outcomes, which gave them more confidence and, in some cases, helped avoid major complications later on.

6. Early referral to true subspecialists can be beneficial. It can shorten the operative time, lower the risk of complications, and may prevent additional organ damage.