This topic is about someone who currently has a well-functioning ileostomy after surgery for ulcerative colitis. They are considering whether to keep it or go through two more surgeries to get a J-pouch. They are curious about the experiences of others who have had a J-pouch, especially those who enjoyed it for a while but eventually had to give it up. They want to know if those "good years" were worth it or if they would have preferred to stick with a permanent stoma from the beginning.

Here are some points to consider:

1. The surgeon has given three options: do nothing, remove the rectal stump for a permanent ostomy, or schedule J-pouch construction within a year.

2. The surgeon provided five "stoma buddies" who are happy with their J-pouches, but the poster wonders if this positive outlook is common.

3. They are concerned about the consequences of losing more small bowel if the pouch fails, such as issues with nutrition and dehydration.

4. There is a noticeable difference between the surgeon's confident success stories and the mixed reviews found online, leaving the poster unsure of whom to trust.

Advice and insights shared include:

- The type of disease matters. Crohn’s patients are generally not good candidates for a J-pouch due to a high risk of reinfection or failure, while those with ulcerative colitis tend to have better outcomes, though complications like pouchitis and cuffitis are common.

- Benefits of staying with a stoma include immediate and lasting relief from pain, medication side effects, and urgency. There is no need for antibiotics, fewer nighttime accidents, and a more predictable routine. It also avoids additional surgery, loss of small bowel, and adhesions.

- Benefits of a successful J-pouch can include feeling "near-normal" for many years, with no external bag, a broad diet, and an active lifestyle. Some people report 18-25+ years of excellent function and would choose it again. The best outcomes are seen when the patient is young, healthy, has ulcerative colitis (not Crohn’s), and an experienced surgical team.

- Risks and drawbacks of a J-pouch include a 50% long-term failure rate quoted by some surgeons, with many "successes" relying on chronic antibiotic rotation. Possible complications include pouchitis, cuffitis, fistulas, leaks, sepsis, incontinence, stenosis, the need for additional surgeries, and eventually returning to an ostomy with less remaining bowel. Radiation damage, diabetes, or extensive prior infection can increase the risk of failure.

- Suggestions for making a decision include asking the surgeon for contact with patients who are not happy with their pouches to compare both sides. Research complication rates, average 6–10 stools per day, and long-term quality-of-life data. Consider whether you’d regret not at least trying the J-pouch, as age and overall health influence tolerance for further surgery. Factor in future travel, sports, and social situations, such as bathroom access versus appliance management. Be aware that surgeons may have a financial incentive for J-pouch procedures, which could introduce bias.

- A peer-run site, j-pouch.org, is recommended for additional first-hand experiences and data.