This topic is about exploring alternatives to a J-pouch for someone who has had a significant portion of their small bowel removed. The person in question previously had an ileostomy, but due to complications, a section of their small intestine was removed. Their surgeon is advising against a traditional J-pouch and suggests a different surgical approach. Here are some insights and advice on the options available:

1. Surgical options after an ileostomy revision:
- Directly connecting the remaining small intestine to the large intestine (ileo-colonic/ileo-rectal anastomosis) without creating an internal reservoir.
- Koch Pouch, which is a continent internal ileostomy that is emptied using a catheter through a skin valve.
- BCIR (Barnett Continent Intestinal Reservoir), a modified version of the Koch Pouch.
- T-Pouch, a newer continent variant developed by Dr. Andreas Kaiser.

2. Considerations for a J-Pouch:
- A J-pouch uses additional small intestine to create a reservoir, which can increase the risk of Short Bowel Syndrome after a 70 cm resection.
- There is a possibility of developing chronic pouchitis. Some people have experienced several good years with a J-pouch, followed by years of pouchitis and eventual failure.
- Revising a failing J-pouch might lead to further loss of small bowel, increasing the risk of malabsorption.

3. Experiences with direct connection:
- Some individuals have experienced continuous liquid output for about a year, with varying degrees of improvement.
- Due to the small intestine's limited ability to absorb fluids compared to the colon, long-term loose output is expected, and diaper use might be necessary during the first year.

4. Notes on Koch/BCIR/T-Pouch:
- These are specialized continent internal ileostomies, and they may not be covered by all insurance plans due to their patented or proprietary nature.
- There are fewer surgeons who perform these procedures, and expertise is crucial. For example, King's College London advises caution with Koch pouch revisions.

5. Permanent end-ileostomy:
- Some individuals have chosen a conventional external ileostomy, finding it offers relief from pain and simplifies daily routines compared to the challenges faced with a J-pouch.