This topic is about the challenges faced by someone with familial adenomatous polyposis (FAP) who is trying to undergo J-pouch reconstruction. The person had a subtotal colectomy in 2007 and continued to develop polyps. Their initial attempt at J-pouch surgery led to complications, and now they are dealing with a temporary ileostomy and a painful hernia. The surgeon has been reluctant to proceed with further surgeries until the patient reaches a certain weight, which keeps changing. The patient is seeking advice and recommendations for surgeons who can help without requiring unsafe weight loss.

Here are some helpful insights and advice:

1. Consider finding a new surgeon. If your current surgeon keeps changing the weight goal, it might be a sign of poor communication or care.

2. Reach out to an ostomy or stoma nurse for recommendations on colorectal surgeons who are experienced with patients who have a higher BMI.

3. Get multiple opinions before proceeding with any more surgeries. You are not obligated to stay with the hospital where your current surgeon works.

4. Some recommended high-volume colorectal specialists include:
- Dr. Stephen Wexner at the Cleveland Clinic in Ft. Lauderdale, Florida, who has extensive experience with FAP and pouch surgeries.
- Dr. Joel Bauer and his partners at Mount Sinai Hospital in New York City, known for their excellent surgical techniques.
- For issues related to the liver or duodenal surgery for FAP, Dr. Sarmento in Atlanta is recommended.

5. Contact the Crohn’s & Colitis Foundation for referrals to surgeons.

6. Many patients with a weight similar to or greater than 180 pounds have successfully undergone J-pouch or reversal surgeries when performed by experienced specialists.

7. Persist in requesting imaging, such as a CT scan, through a new surgeon to assess the pouch pathway, hernia status, and suitability for reconstruction.

8. Be aware that unrepaired stoma hernias can worsen with weight loss. Mesh repair is a common procedure and should not be denied based solely on body size.

9. Avoid prolonged starvation diets. Proper nutritional optimization, rather than drastic restriction, is the standard approach before surgery.