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Posted 7/20/2012 1:58 AM (GMT -5)
I am wondering what the pros and cons are between opting for one type of surgery over the other when having the colon removed. Does having the first surgery done laparoscopically affect the ease or difficulty of the second takedown surgery to connect the j-pouch?
Posted 7/20/2012 7:01 AM (GMT -5)
I know there are some pros and cons for both.  For open surgery, I believe the risks for adhesions are higher, and the recovery is much longer.  For laparoscopic, you can be under anesthesia for a lot longer, which can come with its own set of risks. 

I had my surgery done both ways.  The colon removal aspect was done laparoscopically, and the rectum was removed through open means.  I have a five inch incision right under my navel and a few much smaller sites.  I also had two drain sites.  My first surgery took eight hours.  I believe it was more difficult to recover because I was under that long.  I really felt the impact of the anesthesia, there is no doubt about it.  The plus side is that there was very little scar tissue, and I have had no problems from adhesions so far. 

Posted 7/20/2012 7:01 AM (GMT -5)
anytime you have the option.... you gotta go laparoscopic. if your surgeon can do it lap that is. healing time isfaster, less trauma to your tissues, less internal scarring (adhesions) that cause many of the stoma blockages people talk about on here. its alot easier on your body and less painful than cutting straight through the abdominal muscles with a big midline incision. but if you HAD to be opened its still not the end ofthe world :) i would say if you have time on your side, find a really good colorectal surgeon that does laparoscopic colons and go that route.
Posted 7/20/2012 8:33 AM (GMT -5)
For jpouch surgery, go with the surgeon with the MOST experience, not the surgery style. If you can find a surgeon who does lapro AND has done hundreds of jpouches than that's your doctor. Jpouch surgery is extremely complicated and therefore you want THE best possible surgeon. Do not go to your local community hospital or the VA........experience should be your #1 criteria.

I had my jpouch surgery performed by a CR surgeon who had done over 2,000 jpouches. Mine was open surgery, surgery took 1.5 hours, and I was back to work 3 weeks after surgery. My open scar is less than 5" and looks very similar to those who have had lapro.

Sue
Posted 7/20/2012 10:21 AM (GMT -5)
Laparoscopic cuts down big time on scar tissue in turn you will have less chances of having adhesions that cause blockages. I was fortunate that the surgeon I chose preferred the laparoscopic technique. On the same note, he was very experienced with doing it that way. Recovery time is quicker too. No matter how it's done, the most important thing is how experienced the surgeon is. If he/she happens to do it laparoscopically, then that's a bonus in my opinion.
Posted 7/20/2012 12:26 PM (GMT -5)
I'm lucky to live in the Boston area where I've been given the names of two top surgeons; one does open, one laparoscopic. Both have almost 1,000 procedures under their belt. The laparoscopic guy is further away in the Burlington (Lahey), the other's in Boston (Boston Medical but may be relocating to Mass General). I'm in metrowest... I'm trying to figure if on type outweighs the other...

From what I'm reading, seems laparoscopic keeps you under anesthesia longer with longer procedure length but easier recovery? Are there any complications that are more prone to happen with one than the other?
Posted 7/20/2012 2:14 PM (GMT -5)
Im not sure about any other complications with one over the other but it is true that you would be under anesthesia longer with lapo. I had the colectomy and the j pouch creation done at the same time and I was in he OR for 8 hours. I think I would have chickened out if I had known I'd be out that long! I had no idea...I never asked that question so it's a good one to ask.

Sounds like whoever you chose you will be in good hands. Boston had great hospitals with great surgeons. Good luck with your decision. :)
Posted 7/20/2012 3:38 PM (GMT -5)
You can afford the extra time with anesthesia in my opinion seeing patients in surgery for years. If you have the choice definitely go laparoscopic especially of hes really experienced. It really helps with recover tome and adhesions that cause more problems than its worth if it can be avoided. I dont want to seem like im pushin you one way or the other but i couldnt imagine choosing open abdominal surgery unless absolutely necessary. Much higher risk for infection open as well post op. just tryin to save you the extra time and safety! :)
Posted 7/20/2012 3:53 PM (GMT -5)
Dbtennessee, I am still dealing with the consequences of anesthesia from my first surgery. I would choose the method that has you under for the least amount of time. Supposedly my short term memory will improve. It has been more than a year and I have not seen any improvement.
Posted 7/20/2012 4:38 PM (GMT -5)
Woah thats wild! Yea it can have some wild effects i just speak from seein the complication risk in general i guess. Anything above eight hours under is pretty risky both ways! I only chimed in from my work background in surgery. Mine is august 1 and i definately chose lapro but things can go awry either way. I suppose its whatever your most comfy with. :)

God bless!!!
Posted 7/20/2012 10:02 PM (GMT -5)

Subzeromambo said...
Dbtennessee, I am still dealing with the consequences of anesthesia from my first surgery. I would choose the method that has you under for the least amount of time. Supposedly my short term memory will improve. It has been more than a year and I have not seen any improvement.

Wow I have noticed my short term memory is awful. I never made that connection. I'm 44 so I I always blame my age. (not that 44 is old but....) I was under for 8 hours. Did you ask a doctor about this?
Posted 7/20/2012 10:20 PM (GMT -5)
Go laproscopic! Trust me I am the Queen of Adhesions from open surgery. Go Lap! I should make up a cheer for Lap surgery. Rosemary
Posted 7/21/2012 1:18 AM (GMT -5)
Marianne,
Yes I interviewed two anesthesiologists before my second surgery. Both said that can happen after more than five hours. My emergency surgery was 5-1/2 hours. Both also said my short term memory would come back. My j-pouch surgeries were 2-1/2 hours and 1 hour.
Posted 7/21/2012 6:17 AM (GMT -5)
subzero -- didyou have have post-op delirium?
Posted 7/21/2012 6:18 AM (GMT -5)
another thought - I think the question is how much longer is laproscopy than open surgery?
Posted 7/21/2012 6:56 AM (GMT -5)
Every surgery time depends on the circumstance and surgeon expertise. Generally emergencies tend to last longer because something is compramised and they open you. Especially when its bowel it can be a big mess and dangerous! My heart goes out to the ones on here that have had those emergency surgeries. Im so thankful i get to choose the laprascopic approach! Not sayin my experience will be perfect because i dont know and dont claim to know, but i trust my surgeon and def wouldnt choose to do it open since im given the choice. But theres no way to pinpoint anesthesia time on any surgery really. We have docs that do gallbladder surgry in 30 minutes and some take 2.5 hours. Depends on surgeon and situation. But for my personal choice would have to be lapro. Subzero- i hope your memory gets better! That is a scary complication! But just think, heart surgeries are 5-8 hours on average!!! Im sorry you had such a wild complication! That would definately scare me!

God Bless!!!
Posted 7/21/2012 10:09 AM (GMT -5)
     I suppose it depends on the circumstances and the surgeon.  At time of surgery, I was 63 (almost 64) yrs old....VERY sick, prednisone dependent, extremely high blood pressure with prednisone induced diabetes.  My surgeon wouldn't even consider lapro for me nor would he consider doing j-pouch.  I told him I had no problem with the idea of wearing a bag....I just wanted my life back.  He insisted I pass a stress echocardiogram before he did surgery.  Thankfully, I did.

     I was told my surgery lasted about an hour and a half, but they kept me in ICU a bit longer than anticipated.  My hubby and daughter could not remember why, guess they didn't want to scare me.  I was hospitalized 11 days and had some post surgery complications while still in the hospital, thank GOD, and received top notch care.

     You cannot even see where I was stitched, not that I wear bikinis anymore tongue   and so far (hope I don't jinx myself), have not had adhesions or blockages.  This past June 28th marked my 2nd anniversary of my "new UP free life"!!!

     By the way, in addition to my wonderful family, many thanks to all you supportive people in this forum with a "special" thanks to Suebear who made me "see the light!"

Posted 7/21/2012 10:42 AM (GMT -5)
One thing I forgot to mention in my earlier post is that if you are a woman who wants children, then laparoscopic is the way to go. Again because of less scar tissue build up.
Posted 7/21/2012 1:42 PM (GMT -5)
I had my surgeries done in three steps and went the open route. I agree that the most important thing is to find a really good surgeon who has done a lot of these surgeries. My surgeon at the Cleveland Clinic only does the open surgeries because he thinks the risks outweigh the benefits of the lapro surgery. However, I know there are a handful of doctors there who do it lapro and have great results. My scar is pretty noticeable because I got opened up during both the first and second surgeries. I developed that keloid scarring all along the incision site so it got really wide and raised. I went to a dermatologist earlier this year and she injected some cortisone all along the incision and at my stoma site. It has made it go down quite a bit and lightened it up some. I'm done having kids so internal scarring wasn't a major concern. I think if I was younger I would probably go the lapro route but I'm very pleased with my results overall. Good luck.
Posted 7/21/2012 2:16 PM (GMT -5)

B'Dereh said...
subzero -- didyou have have post-op delirium?

I was in an induced coma after the first surgery. I did not have any delirium after the other two surgeries. Did you have post-op delirium?
Posted 7/21/2012 2:37 PM (GMT -5)
Add me to the list of those who have short term memory issues from being under too long. I noticed it right away that I couldn't even follow a simple conversation with my husband for weeks post op. I am a math teacher, and have always been really good at juggling numbers in my head. It was very difficult for me to go back to work and do problems on the fly with my students. For months after, I had to have my cheat sheet ready and PRAYED that I wasn't observed while teaching a concept that required juggling numbers in my head for multistep problems (luckily I was observed during experimental probability). I definitely improved over time, but I would not say I am the same as I was even now. My new surgeon out of Mt Sinai does not do laparoscopic colectomies. A lot of the good ones don't.
Posted 7/23/2012 4:47 PM (GMT -5)
I had my surgery lapro and was under for about ten hours (surgeon said my colon was long and removing it was "tedious"). I have four tiny scars and that's it.

I kind of feel like I'm stupider since surgery, in a cognitive sense, although wiser in an overall life sense. I'm not sure how much was the surgery and how much was the illness before surgery. With me it's not so much short term memory issues -- I have a hard time pulling up nouns -- people's names that I've known for a long time (but maybe haven't seen the person for a while) and I can't think of an example now, but just the names of things that I don't use a lot. They come to me, but it takes too long.

I know this memory issue can also be a perimenopausal symptom, so hoping it's that (can get better after menopause, I've read).

UC free, that's very scary w/your teaching. As you know, I am also a math teacher, but I've been on sabbatical this past year. That I can still do math and also that I learned all the ostomy stuff, gives me hope, but I do have a bit of anxiety about managing a classroom again -- just haven't done it for a while (but I'm excited too about going back).

Happy camper, my sense is that the main risks of lapro are all about being under longer. Otherwise, the recovery is easier and the complications fewer. The surgery is more difficult to do, though, and fewer people are experienced at it.

I am also in Boston, had my surgery at MGH. I don't actually know how many surgeries my surgeon had done -- I was very sick and on a fast time frame and didn't research as I might have. My gi trusted her and I liked her, so I just proceeded. Went fine....

Good luck w/your next steps.
Posted 7/23/2012 10:07 PM (GMT -5)
I like the "stupider." My hair turned completely white during all of these surgeries so my husband says he finally has his dumb platinum bimbo trophy wife. I gently slug him when he says this. :)
Posted 7/24/2012 9:30 AM (GMT -5)
Nice of you to be gentle, SZM....
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