The topic is about preparing for a consultation with a surgeon regarding a permanent ileostomy, which involves removing the entire colon (total colectomy) and creating a Hartmann pouch to close the rectum. Here are some key questions and considerations to discuss with your surgeon:

1. Surgical Approach and Surgeon Experience
- Inquire if the surgery can be performed laparoscopically and understand the reasons if it cannot.
- Confirm the surgeon’s experience with similar procedures, including permanent ileostomy and total colectomy.
- Document your preferences, such as whether to remove the rectum, to ensure they are followed during surgery.

2. Decision on the Rectum: Remove or Retain
- Consider removing the rectum to avoid future cancer risks, mucus discharge, and the need for another surgery.
- Some choose to keep it to prevent potential nerve damage affecting urination or sexual function, or for possible future reconnection. Mucus can be managed with irrigation or warm enemas.
- If retaining the rectum, discuss cancer monitoring, mucus management, and the option of later removal.

3. Barbie/Ken-butt Closure Details
- Clarify if only the anus will be closed or if the buttocks will also be stitched for extra protection, as this can affect healing.
- Ask about healing time, infection risks, the need for packing cavities, and the use of dissolvable sutures.

4. Stoma Siting and Construction
- Ensure the stoma site is marked while standing, sitting, and bending to avoid skin folds, the belt line, and bony areas.
- Discuss the ideal stoma length, typically 1–1.5 inches (2.5–4 cm) with a slight downward angle for better drainage and skin protection.
- Be aware that stoma size may change over time, and revisions or prolapse can occur.
- Request a sample pouch to test its placement on your abdomen.

5. Post-operative and Long-term Issues
- Discuss the risk of parastomal hernia and preventive measures like surgical mesh or support belts.
- Plan for night-time emptying, as you may need to get up once or twice; discuss strategies for managing high output.
- Clarify the possibility of needing a blood transfusion or additional procedures and how these will be communicated.

6. Follow-up Care
- Determine the frequency of follow-up visits, access to a stoma nurse, and supply availability.
- If the rectum is retained, schedule regular sigmoidoscopies, which can range from every 6 months to every 1–5 years, depending on individual needs.

These points are gathered from the experiences of others who have undergone similar surgeries and can help guide your discussion with the surgeon.