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Newbie with Ileostomy takedown question?

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Newbie with Ileostomy takedown question?

Postby adina91 » Wed Aug 25, 2010 7:00 pm

Hi! My name is Adina. I am actually not so much a newbie to the board or CC, but I am coming out of lurkdom to ask a question.

I am scheduled for Ileostomy takedown October 18th after a subtotal colectomy w/hysterectomy last May. I was first diagnosed with CC in late November 2009 after a severe blockage brought me to the ER and a CT scan showed a tumor in the sigmoid colon. Emergency sigmoidectomy with temporary colostomy was performed where it was discovered that there were actually two primary tumors in the sigmoid. This led the docs (correctly) to believe it was a genetic cancer. Both my father and his father died of CC at relatively young ages. I tested positive for Lynch syndrome with an MSH2 mutation and told to seriously consider prophylactic hysterectomy and subtotal colectomy. But, the oncologist wanted me to complete 6 months of FLOX chemo first. My initial staging was stage 2B. But, a PET scan shortly after my sigmoidectomy and before chemo started revealed a possible tumor in the right colon with an enlarged node.

While I was going through chemo treatments, a couple of colonoscopies were attempted to verify the presence of another tumor but my stoma had stenosed so dramatically, they could not even get a pediatric scope in. The virtual colonoscopy was inconclusive. It was then decided that I would have the colectomy/hysterectomy with ileorectal anastamosis at the end of June. However, another severe blockage situation led me to have the surgery in May and the ileostomy placed. It was confirmed that there was a third primary tumor in the right colon with 1/42 lymph nodes affected which changed my staging to Stage 3A. My oncologist decided to just have me complete the last 3 months of chemo which I recently did and now have a had a clean CT and a CEA that dropped from the hundreds to 0.7.

Anyway (sorry this is so long winded) my question has to do with which incision the surgeon usually uses for the takedown? I assumed that the main vertical incision would be used, but I have seen a few people mention that the incision used to create the stoma could be used too. Laparoscopy is not possible to due severe scar tissue formation.

Thank you for any possible input any of you can give me. I know there have been a lot of topics devoted to ileostomy takedown but this was one answer I could not find.

Adina
P.S. Are adult diapers a definite purchase in my near future? :D :D
Adina 41 yo, mom of 2 sons (5,9)
11/2009 - DX-2B CC-Sigmoid resect/colostomy
Lynch Synd MSH2
1/2010 - FLOX chemo
5/2010 - Subtotal colectomy/hyster/ileostomy
Stage 3A - 1/42 LN +
8/2010 - Chemo done
10/18/2010 - ileostomy takedown
6/2014 - NED
adina91
 
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Location: Los Angeles, CA

Re: Newbie with Ileostomy takedown question?

Postby Lillian » Wed Aug 25, 2010 7:16 pm

My doctor used the stoma opening, but my situation was fairly simple.

I used Depends for a few weeks but really it was not necessary. Pretty quick I switched to Tampax type pads and now I just wear a panty liner all the time - just in case.
49 years old
diagnosed 9/08 - stage 3 rectal cancer
radiation and Xeloda - 5 weeks
surgery 1/5/09 - 22 cm of colon removed and temp ileostomy
chemo to start 2/09 - 7/09 - 12 cycles of Oxaliplatin and Flourouracil w/ pump
ileostomy reversed Oct 09
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Joined: Fri Jan 02, 2009 11:57 pm

Re: Newbie with Ileostomy takedown question?

Postby SkiFletch » Thu Aug 26, 2010 12:26 pm

Little bit of a unique situation here. Can't offer much help myself, but I'm gonna bump this up for you :)
11/13/09 5cm Stage IV 9/25 lymph nodes w/2cm peritoneal met at 29 YoA
12/15/09 LA right hemi-colectomy
6/16/10 Folfox FINISHED
8/10/10 Prophylactic HIPEC
10/9/10 got Married :D

"Can any one of you by worrying add a single hour to your life."
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Location: Buffalo, NY

Re: Newbie with Ileostomy takedown question?

Postby BrownBagger » Thu Aug 26, 2010 12:38 pm

In my case (temp loop ileostomy), all they did was stitch up the two openings and stuff the small bowel back into the hole. They couldn't staple it shut, so I had to wet dress it twice a day for about a month until it healed. Today, it's a scar about an inch long and perhaps a quarter-inch wide, and getting steadily smaller over time. The surgery was nothing compared to the LAR that got me there in the first place.
Eric, 56
Dx: 3/09, Stage 4 RC
Recurrences: (3/lung)
Major Ops: 5
Chemo Rounds (career): 83
Bicycle miles post-dx 10,346
Motto: Live your life like it's going to be a long one, because it just might, and then you'll be glad you did.
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Location: Central NYS

Re: Newbie with Ileostomy takedown question?

Postby Guest » Thu Aug 26, 2010 3:04 pm

Thank you Ski for bumping...

Eric - That is really interesting. I wonder what the difference in decision making is between the loop ileostomy and just a regular ileostomy? When they closed up the colostomy opening, the did staple it, but I did have a bit of an opening that I was instructed to just keep dressed with gauze and neosporin. It closed completely within a couple of weeks after that.

Thank you everyone for looking. This site has really been a major source of help and encouragement this past year (even though I was just lurking :oops: )

I guess a call to my surgeon is probably the best way to find out what I need to know lol.
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Re: Newbie with Ileostomy takedown question?

Postby adina91 » Thu Aug 26, 2010 6:33 pm

Ski - Thank you for bumping!

Eric - I wonder what goes into the decision to do a loop ileostomy or regular one? I am glad that the reversal was easy in comparison to the first surgery. Oddly enough, my colectomy/hysterectomy took less out of me than the sigmoidectomy last year.

Obviously, a talk with my surgeon is in order...lol. I don't know why I forgot to ask during our consult yesterday!

Thanks everyone for looking. I have appreciated this board so much in the last year for advice and information (even though I was a lurker :oops: )

Adina
Adina 41 yo, mom of 2 sons (5,9)
11/2009 - DX-2B CC-Sigmoid resect/colostomy
Lynch Synd MSH2
1/2010 - FLOX chemo
5/2010 - Subtotal colectomy/hyster/ileostomy
Stage 3A - 1/42 LN +
8/2010 - Chemo done
10/18/2010 - ileostomy takedown
6/2014 - NED
adina91
 
Posts: 485
Joined: Wed Aug 25, 2010 6:36 pm
Location: Los Angeles, CA

Re: Newbie with Ileostomy takedown question?

Postby GreenLakeGirl » Thu Aug 26, 2010 9:22 pm

I'm guessing the loop ileo is used when the surgeon is not using the end of the small intestine. They used the side or a loop of the small intestines to allow the remaining tissue (j-pouch or colon) to heal without waste passing through it. The regular ileo allows the end of the small intestine to come to the skin's surface.

I wonder why some surgeons use sutures and others, staples. My guy's a suture guy, and his work is really tidy, but I read that a lot of bowel work gets staples because of the bacteria in the gut. I'll have to ask him the next time I'm in.
2009, age 37 with a 2yo: CC, IIIB (T4N1M0). IBD history
2010-11: FOLFOX, 12 rounds. 5 surgeries (3-step Ileal j-pouch, infection, VATS)
Currently NED.
Mom, you can go the hard way if you want, but the easy way is much easier. ~my 3yo
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Re: Newbie with Ileostomy takedown question?

Postby BrownBagger » Thu Aug 26, 2010 9:32 pm

My guy loves staples. Loop vs. non-loop is an interesting question. Without giving it much thought, I suspect that a loop ileo is a lot easier to reverse, because it's basically intact the whole time. With an end ileo, part of the small bowel is severed, and I'm not sure what they do with it while it's waiting to be reversed. With a loop ileo, it stays basically intact. If it's permanent, then obviously there's no need to maintain the connection between the small bowel and colon, and I suspect the stoma is more functional than with a loop ileo.
Eric, 56
Dx: 3/09, Stage 4 RC
Recurrences: (3/lung)
Major Ops: 5
Chemo Rounds (career): 83
Bicycle miles post-dx 10,346
Motto: Live your life like it's going to be a long one, because it just might, and then you'll be glad you did.
User avatar
BrownBagger
 
Posts: 7142
Joined: Fri Jul 24, 2009 2:56 pm
Location: Central NYS


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