This topic is about understanding how much of the colon can be removed before it becomes difficult to reverse the procedure. The person asking the question has already had a significant portion of their colon removed due to surgeries related to Hirschsprung's disease. They are concerned about the potential outcomes if more of their colon is removed and are seeking advice on what to expect and how to proceed.

Here are some helpful insights and advice:

1. If too little colon remains, there might be a need to frequently locate restrooms due to very frequent bowel movements. Alternatively, there might be a need to convert to an ileostomy with a relocated stoma.

2. A complete colectomy with reversal is possible. Surgeons can remove the entire colon and sometimes part of the small intestine, creating a J-pouch. After the first year, patients may average 5–9 bowel movements per day.

3. To be a candidate for a J-pouch, the anal sphincter must be intact and disease-free. It is not recommended for those with Crohn’s disease, as this often requires a permanent ileostomy.

4. Storage capacity options include:
- A J-pouch alone, which may result in about 6 bowel movements per day after adaptation.
- If the rectum or rectal stump is left intact and healthy, bowel movement frequency can drop to about 2–3 per day with medications like Imodium or Lomotil.

5. Medications and dietary choices, such as Imodium, Lomotil, Metamucil, bran, and careful diet management, can help slow output and thicken stool.

6. Typical intestinal lengths are about 6–8 feet for the colon and 20–30 feet for the small intestine. Surgeons use these measurements to assess remaining capacity.

7. Comparing options:
- A J-pouch maintains normal anatomy without an external pouch but carries risks like pouchitis and strictures. It generally requires 1–3 staged operations.
- A conventional ileostomy involves quicker surgery with fewer re-operations but requires managing an external pouch and monitoring diet and stool flow.
- Patient-reported quality of life after one year is roughly equal between a J-pouch and an ileostomy.

8. When making decisions, ask detailed questions, as surgeons may provide only brief explanations. Review reliable resources like the United Ostomy Associations of America website for more information.

9. Be aware that if Crohn’s disease is later discovered, a J-pouch may need to be removed.

10. Dialysis is unrelated to colon length or bowel surgery; it is strictly a treatment for kidney failure.

11. Personal experiences vary. Some have attempted reversals that failed due to new Crohn’s flares, while others with permanent ileostomies report doing well and chose to keep the pouch after considering the risks of reversal.