This Post Brought to You by the Letter K

I've been waiting a long time to use this title. A little Sesame Street humor, I crack myself up. I know easily amused right?!

As the day of surgery draws nearer, I thought there might be some questions as to exactly what this procedures is going to entail. I'll try and give you the least confusing and most layman's description. Here we go.

First of all, take a look to the right. When the procedure is done this is a diagram of what my pouch will look like on the inside -- cool right?

On Thursday, I'm scheduled for surgery at 12:30. The procedure should take 2-4 hours depending on how much scar tissue there is.

My surgeon will open me up using the same midline incision that was created during my total colectomy back in November 2007. I'm hoping he'll be able to work a little magic when he closes me back up and make my scar look a little neater (I mean he's no plastic surgeon but it can't hurt to ask.)

After opening me up, he will inspect my current j-pouch and assess if he can use it to create the K-pouch. The benefit to this is that he would be able to preserve more of my small bowel. If he can't use the j-pouch tissue because it's too inflamed or damaged, he will create the k-pouch from another part of small intestine. He feels confident that he will be able to use my j-pouch (I've been taking antibiotics last week to get it in pristine shape before surgery) however, he has reiterated a number of times he won't know until it takes a look. Being able to make these judgement calls while a patient is open on the table is exactly why we fought to have the most experienced surgeon!

Before he makes the K-pouch he will remove my remaining rectum and the anal sphincter muscles. He will then sew up my anus (yes my little hole will be gone forever, no more farting for me.) I will have sutures on the inside and outside of the hole that will dissolve over time. I am NOT looking forward to this little wound healing. However I told my hubs no one can call me a butt hole anymore (not that it's a term I've been called since I was younger and have name calling wars with my brother, but I digress.) I will now have a Barbie butt, so you can just refer to me as Barbie from now on;)

After the anus is removed and closed, the surgeon will create the k-pouch, valve and stoma. This is from what I hear the most delicate part of surgery, it takes great precision. I know I am in the best hands so I'm not worried. After he's done with this, he'll sew me right back up. I will have staples in the mid-line incision and a semi-permanent drain will be placed in the stoma to constantly empty the new k-pouch as it heals.

When I wake up from surgery I will most likely have the following tubes sticking out of me -- NG Tube (to drain the contents of my stomach so nothing goes through the digestive system), urinary catheter, the drain in my stoma and possibly some special IV line under my collar bone (not sure exactly what this is for.) Things will slowly be removed as the days go by and my "gut" wakes up.

I will be in the hospital 5-7 days (I say 7 and if I get out early it will be exciting.) During this time I will learn how to care for my K-pouch -- how to intubate and empty, how flush it with water, etc. Aside from when I'm learning the care, for the first three week the stoma catheter will be in place (taped in and connected to a leg bag collecting the waste) for the first three weeks. They say that you can take it out for 15 minutes a day to shower, and let me tell you those will be the best 15 minutes of my day. You know what they say, "A shower always makes you feel better."

After the three weeks are over I'll return for a post-op appt and be able to take the permanent drain out. Then the real pouch training begins. I will have to intubate and empty the pouch on very strict intervals, increasing the time between emptying weekly. This allows the pouch to stretch and retain more waste over time. They say this time can be frustrating and a bit painful as the pouch stretches and I will be able to feel it. Yeah fun times.

So what does all this mean, well about 12 weeks post op the pouch should be mature. I will have to be very careful with food and learn what works best for my system. Remember all the poo needs to come out a tube about the size of your pinky -- so you can see that I will need to find the right consistency to get it out with the least amount of trouble.

I will post more details along the way, but there's the not-so-brief overview of what will happen. I do count on some lovely drug-induced moments while in the hospital. I've got to keep my people entertained don't I.

If you have questions, feel free to leave a comment or email me at the address listed in my sidebar.

Here's to the best future k-pouch possible.