If you're preparing for a proctectomy, which is the removal of the rectal stump, and you already have an ileostomy, you might be wondering what to expect and how to make the process as smooth as possible. Here are some key points and advice to consider:

1. Surgical Approach and Healing
- The surgery involves removing the rectum under anesthesia, closing everything up, and then allowing your body to heal.
- Laparoscopic or robotic surgery usually results in several small scars, while open surgery leaves one larger scar. Sometimes, the surgeon may need to switch to open surgery if necessary.
- Recovery time can vary, but many people find it takes about 6 to 8 months to fully recover.

2. Sitting and Positioning After Surgery
- Sitting can be challenging post-surgery. You might find it more comfortable to lie down, stand, or sit on one cheek.
- When getting out of bed, try to roll out and keep your legs together to avoid putting stress on the wound.
- A "butt pillow" or two folded towels can help keep your cheeks together; avoid using a donut pillow. These are often available at hospitals or can be purchased online.
- Ice packs or chilled washcloths placed between the cheeks can help reduce swelling.

3. Wound Care and Infection Prevention
- Keep the area where the rectum was closed up clean and dry to prevent infection.
- Leakage from the closed rectal area is common, and some people may need further procedures.
- Be vigilant for signs of infection or abscesses and insist on antibiotics if needed.
- Dissolvable stitches are recommended and worth discussing with your surgeon.

4. Activity Restrictions and Home Preparation
- Avoid bending, lifting, or driving for a while after surgery. Walking may initially be more like shuffling.
- Arrange for help at home for the first 1 to 2 weeks and stock up on food beforehand.

5. Stoma Considerations
- If you still need a stoma, ensure it's placed on a flat, visible, and easily reachable area.
- Common stoma positions include the right of the navel for an ileostomy and the left lower abdomen for a sigmoid or descending colostomy.
- Request a protruding stoma rather than a flush one, as factors like obesity, bowel reach, and blood supply can influence its placement.

6. Nutrition and Supplements
- A high daily intake of protein can help speed up wound healing.
- Consider supplementing with vitamins B6, B12, D3, and C before and after surgery, as they may aid in recovery. Some people prefer gummy forms of these vitamins.

7. Finance and Employment
- If you're still working, disability insurance or other income support can be valuable, as surgery-related costs and time off can be financially straining.

These insights should help you prepare for your surgery and recovery, making the process a bit easier to navigate.