Question: Is it possible to opt for an ileostomy or J-pouch surgery without exhausting all medical management options?

I consulted with one of our colorectal surgeons regarding the possibility of undergoing ileostomy or J-pouch surgery without fully exhausting all medical management approaches. The surgeon indicated that while it’s unusual, such surgeries can be performed under certain circumstances.

Response: Weighing the Pros and Cons of Ileostomy and J-Pouch

Choosing between an ileostomy and a J-pouch involves considering both the advantages and disadvantages of each procedure. Here’s an overview:

Ileostomy – Pros and Cons:

  • Pros: Flexible timing for emptying, control over output, fewer surgeries, and typically fewer complications once a suitable pouching system is established.
  • Cons: Potential challenges with stoma placement, cost of supplies depending on location, risk of parastomal hernias, dietary modifications, and dehydration risk.

J-Pouch – Pros and Cons:

  • Pros: No external pouch required, minimal ongoing costs, no risk of parastomal hernias, fewer dietary restrictions post-recovery, and less need for electrolyte replacement.
  • Cons: Multiple surgeries required, potential for initial incontinence and skin issues, disrupted sleep patterns, frequent bathroom visits, risk of pouchitis, and possible need for medication to manage output.

Surgical Options – Two-Stage vs. Three-Stage Procedures:

  • A three-stage procedure includes an initial creation of an end ileostomy, followed by the formation of a J-pouch and a loop ileostomy, and finally, the reversal of the loop ileostomy.
  • A two-stage procedure involves direct creation of the J-pouch and loop ileostomy, followed by reversal, offering no trial period with an ileostomy.

Support and Resources: For those under 50 considering these options, we have established an Ostomy group and a J-Pouch group, providing support and information. To join or inquire further, please contact the following:

Feel free to reach out for an invite to our next meeting where we discuss these options in detail.

Warm Regards,

Lauren Wolfe, RN, BSN, MClSc (WH), NSWOC, CWOCN

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