This topic is about someone who has been living with a "permanent" ileostomy since 2009 due to Crohn’s disease. Now, with the disease in remission, their doctors say a reversal is technically possible. While the idea of not having an external pouch is appealing, there are concerns about potential complications after surgery, the time needed to recover in the hospital, and the chance of frequent bowel accidents. The person is seeking advice and personal experiences to help make a decision.

Here are some insights and advice shared by others:

1. Medical eligibility:
- Some U.S. surgeons are hesitant to create or reconnect a J-pouch for patients with Crohn’s due to the risk of recurrence, especially if the small bowel is involved. However, if there is no small-bowel involvement, some surgeons may consider it.
- Data from the Cleveland Clinic shows that 85% of Crohn’s patients without small-intestine inflammation have a functioning J-pouch 10 years after surgery, compared to 90-94% in ulcerative colitis cases.
- In the UK, surgeons may be more open to reversal if Crohn’s has been inactive for several years.

2. Staying with a permanent ileostomy – reported advantages:
- No risk of developing pouchitis or needing to remove the pouch later.
- Eliminates the risk of cancer in the anal transition zone.
- Avoids the need for a second major surgery and another recovery period.
- No issues with perianal skin irritation or feelings of internal pressure or bloating.
- Bowel management is predictable, and there’s no need to use public toilets.

3. Opting for reversal/J-pouch – reported advantages:
- Being free from an external pouch can improve comfort during activities like swimming, running, and sex.
- Easier to gauge fullness and empty naturally; some find it easier than managing an ostomy bag.
- Lower risk of parastomal hernias since the abdominal wall is closed.
- No need for wafer changes or dealing with stoma-skin problems.
- One person, two months after the procedure, reports having six bowel movements per day and is satisfied with the outcome.

4. Reversal/J-pouch – reported drawbacks and risks:
- Involves another surgery with its own recovery and anesthesia risks.
- There is a possibility of developing pouchitis and future failure, which might require complex re-operation.
- Early postoperative bloating and increased bowel frequency can occur, and perianal skin may become sore.

5. Practical suggestions:
- Consider lifestyle priorities: “Do you want to poop from your side or your butt?”
- Having a trusted person with you in the hospital can lead to better staff attentiveness.
- Think about your overall surgical history and general health, as additional surgery might be more challenging for those with multiple prior operations.