This topic is about understanding the reasons and benefits of choosing a "Barbie/Ken butt" surgery, which involves closing the anus and rectum, after having a permanent ileostomy. Here are some insights and advice shared by others who have considered or undergone this procedure:

- Purpose of the Surgery:
- Once the colon is removed and an ileostomy is permanent, the rectum and anus no longer serve a function. Removing them can prevent infections, abscesses, fistulas, hemorrhoids, and painful mucus plugs.
- For those with very low rectal cancers, complete removal with closure can be lifesaving, as it ensures clear margins.
- In cases of inflammatory bowel diseases like Crohn’s or ulcerative colitis, the remaining rectal stump can stay diseased, leading to chronic inflammation and other complications.

- Mucus Issues if the Rectum is Left in Place:
- The cells in the rectum continue to produce mucus, which can range from rare, small plugs to constant leakage that requires pads, especially during activities like coughing or exercising.
- Some people experience a decrease in mucus over time, and regular exercise and pelvic-floor work can help improve control, though results vary.

- Cancer-Risk Considerations:
- There is a risk that a retained rectal stump can become cancerous, with some surgeons suggesting removal within six years post-ileostomy. However, experiences vary, with some keeping the stump for many years without issues.
- Routine surveillance of a blind rectal stump is challenging, and proctectomy eliminates this concern.

- Timing and Eligibility:
- If the stoma is permanent, it is often recommended to have the proctectomy while the patient is younger and healthier.
- The surgery can still be performed later if issues like mucus, pain, or disease arise.

- Healing and Pain Expectations:
- Healing times can vary, with some returning to work in 8 months and others taking over a year, especially if prior treatments like chemoradiotherapy were involved.
- Pain levels differ greatly; some experience minimal pain, while others find the perineal sutures very painful.
- A technique that temporarily joins the buttocks to reduce tension can help protect the wound but may feel tight or lumpy.

- Complications and Caveats:
- Minor issues like spotting or small leaks from the closed wound can occur and are usually treatable in a doctor's office.
- Prolonged non-healing or unexplained pain should be evaluated by a surgeon.

- Decision Factors Summarized:
- Benefits include no mucus, lower infection and sepsis risk, reduced cancer worry, and no need for rectal maintenance.
- Drawbacks involve major surgery, a lengthy recovery period, perineal discomfort, and variability in healing outcomes.
- Many favor the operation when the ileostomy is permanent, but it is important to discuss personal health, previous treatments, and lifestyle with a qualified colorectal surgeon.