Operations

Pelvic (ileal) Pouch Procedure

Pelvic (ileal) Pouch Procedure

“The pelvic pouch procedure is usually done in two or three stages. Initially, the pouch is formed by folding the small intestine (ileum) back on itself to make a ‘J’ shape. The bottom of the ‘J’ is opened and sewn to the small segment of remaining rectum. The temporary loop ileostomy is created above the pouch (panel 1), and several months later the ileostomy is closed (panel 2), thus producing an intact digestive tract (panel 3).”

Quoted text and diagrams from Steinhart, A.H. and Cepo J. 2008 Crohn’s & Colitis Diet Guide. Robert Rose Inc. Toronto.

temporary loop ileostomy created above the pouch

temporary loop ileostomy created above the pouch

 

ileostomy is closed

ileostomy is closed

side view of pouch

side view of pouch

 

Modern medicine is pretty amazing!

 

My explanations of my operations are a bit unclear. Sorry for any spelling mistakes, especially with some of the medical terms.

 

I was admitted to hospital to have an ileal pouch formed. This is usually done in two or three stages. The first operation I had was on 30th October 2012, it was an elective laparoscopic proctocolectomy and restotive ileal ouch anal anastomosis with covering loop ileostomy. In other words, I had my whole large intestine removed, an internal pouch formed from part of my small intestine and a temporary stoma created as well. A stoma is an opening from the digestive system to the outside of the body, in my case it was formed from part of the small intestine. The stoma was formed to give the wounds around the pouch formation time to heal. After the first operation patients expect to have a temporary stomas for about 2 months in order to regain strength before another operation and to give time for wounds to heal.

 

I did feel very weak after the first operation and the pain from the wound was quite bad. I was told that the operation went well. I did feel that I was getting a little better each day though I was weak, in pain and eating was difficult at first as I felt nauseous at times. I left hospital after ten days. Unfortunately for me I had problems with the temporary stoma. About two weeks after the operation on the 30th October I got very bad pains throughout my abdomin. I was having constant stomach cramp like pains which every 15/20mins would intensify briefly then subside to the aching pain again. I was also not able to eat and was vomiting. The stoma was not working as it should have been either, there was little to no output. The pains ended after about 24hours and the stoma started working better but a couple of days later I experienced the same thing and I went back into hospital. I left hospital after 48 hours but had to go back in a couple of days later when the same thing started to happen. Due to the continued recurrence of the problem and the fact that it was causing me not to eat properly and getting weaker there was talk of bringing forward the reversal of the stoma. I had some tests done to see if the pouch was functioning and would be ok if the stoma was reversed. The tests went well (or at least as well as a test involving things being put up my bottom can go) so the surgeons booked me in for the second operation. I had the second operation on 28th November 2012. I was discharged after this second operation on the 2nd December 2012. So I was allowed to leave hospital four days after the second operation. I wasn’t exactly bouncing off the walls but I was able to walk to the car from the ward.

 

I was told that the problem with my stoma and the pain was as a result of my stomach muscles around the stoma opening. They were constricting too much so not allowing stool to pass through the opening properly causing blockages in my bowel resulting in pain, vomit and feeling weak because of this. There are apparently more problems associated with temporary stomas than permanent ones and I am told that the problem I experienced is rare. The month of November 2012 was not a lot of fun for me or for anyone who saw me or heard from me during that time. Though it was difficult I would do it all over again as I am better now than I was before I had the first operation.

 

I would say my recovery after the second operation has been pretty good. Apparently some people notice a bit of a problem going from the temporary stoma to the pouch but as I had so many problems with the stoma the pouch was great. There are points with some close calls as far as bowel control are concerned but this was mainly not too long after the operation or when I have eaten quite a lot of chocolate or some of the other things which are meant to increase output. I spent so long with such a restricted diet and I have a bit of a sweat tooth that at times I eat some things that cause issues. Not terrible issues as with a UC flare up just little problems.

 

I was able to enjoy Christmas. I went to see friends in Oxford for New Year’s Eve. It was only a small house party and I spent a lot of time sat down but I would not have wanted to do that or really have been able to do that prior to the operation. I would try and go for walks most days to start getting my strength back. From the start of February 2013 I have been going to the gym as well. I would say that I would probably have been able to go back to work (if I had a job to return to) from about a month after the second operation. That is a job that does not involve much manual labour or general physical effort. I have done a bit of part time work over the past few weeks and one of those jobs has involved some manual effort and I have been ok.

 

Post-op. This is after the second operation. You can see the where the stoma was and you might be able to make out where my tummy was opened under my belly button (the stupid amount of hair hides it quite well). The key hole scares are very hard to notice.

Post-op. This is after the second operation. You can see the where the stoma was and you might be able to make out where my tummy was opened under my belly button (the stupid amount of hair hides it quite well). The key hole scares are very hard to notice.

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