2 Stage Surgery. Creation and Connection of JPouch in 1 Operation. Before, During and After!

SILS (Single Incision Laparoscopic Surgery)/TATME (Trans Anal Total Mesorectal Excision) completion proctectomy and formation of J Ileo Pouch, closure of Ileostomy.

This is the technique I underwent in August 2017, I went from a temporary Ileostomy stoma directly to a functioning JPouch in one surgery (technically 2 steps as the first was the removal of my colon and temporary stoma in 2016).

I will cover what, why and how things occurred happened throughout my journey in detail, however, the sole reason for this blog is to share this new revolutionary method that can save months of waiting and recovery compared to traditional 3 stage surgery with the same outcome.

I have been diagnosed with Indeterminate Colitis (IC) and due to continued illness despite all available medications and interventions, my Colon was removed in Feb 2016 at Brighton University Hospital in the UK. I had a Subtotal colectomy via laparoscopic surgery with just one major incision made in the abdomen and several small laparoscopic incisions above, and formation of Ileo Anal Stoma (ileostomy stoma)

Following this I continued to suffer chronic inflammation and ulcers in my dysfunctional rectum, therefore I needed to have the next step as soon as I could, I was on the waiting list at Brighton for 14 months, however, it was not looking likely to be any time soon, my stoma nurse recommended I could get referred to another hospital. She gave me information on 2 top surgeons she had knowledge of, and I contacted St Marks Hospital in Harrow, Middlesex, UK. After researching many surgeons, I elected to be referred by my GP to Mr Janindra Warusavitarne B Med FRACS PhD, Consultant Colorectal Surgeon.

I met with Dr Warusavitarne at the end of May 2018 and after several meetings and examinations, was booked into surgery for stage 2 of my JPouch formation, this was planned to be a temporary loop ileostomy and JPouch formation, However, we discussed that, as I had had my previous surgery with minimal intrusive openings, I would hopefully have minimal scar tissue or adhesion's. He suggested that it may be possible, if I agreed, to have the final stages done in 1 step, skipping the temporary loop stoma and going straight to formation and connection of the JPouch in one.

This was an extremely exciting yet scary option, it was a very new procedure, and, in fact, Dr Warusavitarne was the founder of the pioneering technique to perform single stage surgery via a single point of entry, laparoscopic and via the rectum with just incisions for drainage to be made externally. I would eventually be one of the first to have this technique.

This is technically known as SILS (Single Incision Laparoscopic Surgery)/TATME (Trans Anal Total Mesorectal Excision) completion proctectomy and formation of J Ileo Pouch, closure of Ileostomy.

I was booked into for the 11th August 2018 with a pre-op appointment a few weeks prior. The pre-op appointment was extremely informative and reassuring. I had bloods and other tests carried out and they went through where, who, how and when things would happen on admission and care after.

The morning of the surgery we headed to the ward as advised and I was prepared for the op. I was to be first in and it was thought surgery would last between 4-7 hours depending on the outcome, as the surgery progresses the Dr would assess and make the decision as to what stage I was going to have!

The Surgery!

All I remember is that I desperately didn’t want to wake up with a stoma bag! I didn’t want loop stoma, I had heard so may issues with leakage etc due to the fact they are shallow and close to the body compared to the temporary stoma I had. I was also extremely anxious as I had such a terrible reaction to medications after my first surgery and was still suffering PTSD from that.

I went down and after just 5 hours I was in recovery! I remember so clearly looking down and seeing a wound dressing, NO BAG! A huge wave of relief fell over me! I knew I had a huge recovery ahead of me but potentially this was my final surgery and the relief was immense!

I spent several hours in and out of consciousness, my body was exhausted, I needed sleep, Stuart was at my side and I rested, I was on a decent dose of Oxycodone via drip and it managed the pain well. The next day or so is a bit of a blur, I had my pain managed so well on the Oxy and with its immediate effect, I was comfortable. I had a catheter in my bladder and initially in my bowel.

It took around 2 days for my bowel to fully wake up, I was now on