rewinj I am 62 with an ileostomy since 2014. The best that I understand is that if the lower third of you system is damaged the removal is generally thought to be the best procedure because of the possibility for rectal cancer in the rectal stump and anus. BUT YES by all means get a second and if you are still wondering a third opinion, preferably by a surgeon from another facility. I have discovered that surgeons do not like to discuss procedures that they themselves are not capable of performing. Having an ileostomy, I have only recently learned about the BCIR procedure, whereby the rectal stump is removed, a barnett continent internal resevoir is formed out of the last 2 feet of small intestine and elimination takes place from a very small incision just above the pelvic bone, where a small catheter is inserted by you two or three times a day to empty waste. It requires no outside appliance and is covered by a small band aid. This is the latest improvement on the KOCH pouch which along with the J POUCH and IAAP are the most ofter performed procedures. Again, the last third of you system being what is damaged, it kind of takes you out of the picture for being able to have a typical J Pouch, etc, because with that you evacuate your waste as any normal person, by sitting on the toilet. I have been to a seminar about this procedure, and webinars are available online for information. AS far as differences between ileostomy and colostomy, I'm not sure of the real differences except that I am aware that ileostomy patients are considered the best candidates for the BCIR. I heartily urge you to do the research, because I can promise you that your surgeon will suggest what he/she is capable of doing, and may not even discuss the BCIR. Mine didn't. Again, check online there is a lot of data and many webinars from Palms of Pasadena Hospital in St. Petersburg, Fla. and also OlympiaMedical Center in LA> California, the only two hospitals that I am aware of that perform this procedure. And yes, no matter what you decide and what the outcome, it is worth the time and energy to make yourself comfortable with your decision.