The topic at hand is about whether the skill of a surgeon influences the likelihood of experiencing blockages after having an ileostomy. An ileostomy is a surgical procedure that creates an opening in the abdominal wall to allow waste to exit the body. The person who started the discussion has had an ileostomy for 18 months and has never experienced a blockage, despite not always being careful with their diet or chewing thoroughly. They wonder if the skill of their surgeon might be the reason for their smooth experience.

Here are some insights and advice shared by others:

1. The skill of the surgeon is generally not linked to food-related blockages. While a skilled surgeon is crucial for avoiding complications like leaks, infections, and poorly formed stomas, blockages are mostly influenced by diet and eating habits once healing is complete.

2. Common causes of blockages include:
- Large, poorly chewed food particles that can get stuck where the bowel exits the abdominal wall.
- Foods that are typically considered high-risk, such as popcorn, certain raw vegetables, and fruit skins.
- Changes over time, as foods that were once tolerated can become problematic, and scar tissue or adhesions may develop long after surgery.
- Parastomal hernias, which can narrow or kink the bowel, increasing the likelihood of blockages. Repair surgery often helps reduce these episodes.

3. Thorough chewing is the best way to prevent blockages. One surgeon recommended chewing each bite 60 times for foods known to cause issues. Not chewing well is compared to playing Russian roulette, as the odds of a blockage may eventually catch up.

4. Blockages can resolve on their own or may require medication, emergency surgery, or in severe cases, can be life-threatening. It's important to take the risk seriously, even if you haven't experienced a blockage yet.

5. Adhesions, which are internal scar bands, are another known cause of blockages. Some surgeons believe most blockages are due to adhesions that restrict bowel movement, though not everyone develops them.

6. There is significant individual variation. Some people may experience blockages with foods that others can eat without issue. Unlike a rectum, a stoma cannot "strain," so particles that once passed naturally may now cause obstructions.

7. It might be luck or individual body differences, rather than the surgeon's skill, that explains why some people never experience blockages despite not being careful with their chewing. It's important to stay vigilant and adjust your diet and chewing habits as needed.