I had my final pre-op appointment with my surgeon today. We talked about the procedure. My concerns. Her concerns. In light of the problems last time, rather than just jump right in and do the takedown, she’s going to take a look a laparoscopic look at the outside of my pouch to look for any abnormalities. This will lengthen the surgery a bit, but is well worth it to avoid what happened last time. If she sees no problems, she’ll proceed. If she spots something unusual (e.g., a narrowing of the intestine somewhere), she will open up my abdomen for a better look and, if possible, to correct it, before doing the takedown. But hopefully it doesn’t come to that.
As a further precaution, we are going to another pouch-o-gram (CT scan with gastrografin contrast) next week to check for leakages or any abnormalities in the pouch. When I had a pouchoscopy in December, my GI saw a slight bump or narrowing of the intestine at the top of the pouch. My surgeon didn’t see it when she did an exam under anesthesia in April, but a pouch-o-gram should show it. If there is a bump/narrowing that is constricting flow into the pouch, it could explain some of pouch function problems I had last time. A restricted entry into the pouch is likely to result in liquidy waste entering the pouch (as it’s “squeezed” through the restriction), and the pouch does not tolerate liquid waste very well, resulting in a sense of urgency. If we see an issue (or a potential issue) on the scan, my surgeon will know what to look for in the OR (and can fix it). But, again, hopefully it doesn’t come to that.