In February 2021, Sunnycd wrote:I was supposed to have my colostomy reversed “6 weeks” after the surgery. If I have the chemo, it will probably be more like a year or so after surgery. I know that the sooner I have it reversed, the less side effects from it I will have (incontinence, etc). Besides, I CANNOT bear having this bag, I have painful skin issues, and bleeding and sometimes, I’d rather spend hours in the bathroom to avoid the inevitable “pancaking”...
In March 2021, Sunnycd wrote:... I also asked about my colostomy reversal, which I plan on doing as soon as I can. After my previous experience, I almost feel that I wouldn’t have needed it had I been operated by someone at MSK. She said she could give me a name, but for reversals, I’m better off w the original because they know my physiology already. I agree with her. My surgeon seemed pretty good, though since it was an emergency surgery, I only saw her briefly when she was checking on me, and later to get my pathology report.
In May 2021, Sunnycd wrote:... Lots of research on colostomy reversal. I need to meet w my surgeon to go over it, and understand my situation better because I really didn’t talk to her after the one follow up apt after surgery. She is a colorectal surgeon, but I wonder if I should ask my msk oncologist to refer me to someone and get 2 perspectives. I understand the wide range of experiences and after being depressed and worried about the worst outcomes, at this point, I want to focus on everything I can control and do for a successful outcome. I am making a list, checking it twice and searching this forum. If anyone has any pointers, it would be greatly appreciated. Specifically, I am focusing on this:
1. Doing lots of exercises, physical activity before the surgery. After surgery, lots of walking and meditation. Insight Timer app is a must in case you are interested.
2. Specific diet several weeks prior to? I know what I should eat or not eat after, but not sure before. Prebiotic, probiotic, supplements?
3. Got bidet, wet wipes, Imodium, miralax, metamucil, depends, squirt bottle, ointment calmoseptine
What else am I missing?
Green Tea wrote:There are still some things about the emergency surgery that need to be clarified, in my opinion. For example:
I guess it's the latter question that is so puzzling to me. In your surgeon's online profile it is mentioned that she has "expertise in colostomy avoidance." But if that were the case, then why did she set up an ileostomy for you when the tumor was far away from the anal verge? This is a bit puzzling to me. Maybe this is something you could bring up with the surgeon the next time you talk with her.
- Why was this an emergency surgery? Was there a verified blockage? Was there a perforation?
- If this was a T4a tumor, then where was the tumor intruding? In which direction? Close to which other organ ?
- What kind of surgery was actually done? Sigmoidectomy? Left hemi-colectomy? Mesocolonic excision?
- What type of surgical approach was used? Laparoscopic surgery? Robotic surgery? Open surgery?
- At what height in the rectum was the anastomosis junction made? Upper rectum? Mid-rectum? Lower rectum?
- Do you have any CT scans with contrast, or any MRIs that would show where, exactly, the anastomosis junction was placed?
- Why did the surgeon install an ileostomy when the primary tumor was in the sigmoid colon, not in the rectum?
Meanwhile, just try to concentrate on finishing your CAPOX regimen by mid June. Take care, and keep safe !
Green Tea wrote:I am not very familiar with your type of "end colostomy", so I will have to do some more research before I can make sense out of your surgery. Apparently it is possible to reverse an end colostomy, but it is a more difficult operation than a simple loop ileostomy reversal.
For now, I have a few more questions to ask:
Thank you in advance for any additional information that you can provide.
- How long did your surgery last? How many hours?
- How long did you have to stay in the hospital after the surgery before they discharged you?
- Did you have any difficulties during the recovery period, for example wound healing problems or wound infections?
- Once you were discharged to go home did you ever have to be re-admitted to the hospital to take care of any post-surgery problems that developed?
- Where is your colostomy located? Left side of abdomen or right side of abdomen?
- How many scars from your surgery? How long was the longest one, and where was it located? Was it horizontal or vertical?
Hartmann's Procedure with an End Colostomy
"This operation was first described by Henri Hartmann, a French surgeon, in 1921. It is a common emergency operation and is used when the surgeon does not want to rejoin the bowel. Similarly to a left hemicolectomy or anterior resection, the pathology is in the descending or sigmoid colon or rectum (shown as red in diagram below). The pathology is excised but then in this case the surgeon decides that they do not want to make an anastomosis usually because there is peritoneal contamination or the patient is particularly sick and there is a risk that the blood supply to any anastomosis would be compromised and unsafe. Therefore the surgeon closes the distal resection margin (bold straight line at top of rectum below) leaving a rectal stump (see diagram below) and they bring out the proximal resection margin (upper bold straight line in diagram below) through the anterior abdominal wall to make an end colostomy (blue oval in diagram below). If the patient recovers from this operation then there is a possibilty that they can have their colostomy rejoined on to their rectal stump at a later date and this is called Reversal of Hartmann's operation. Reversal of Hartmann's procedure can be carried out in the open fashion via a large midline abdominal incision or in the modern laparoscopic fashion via small keyhole incisions."
"To recap a Hartmann's operation always has a rectal stump made and it always has an end colostomy formation."
Diagram of Hartmann's Procedure with an End Colostomy
"Hartmann's operation or Hartmann's procedure is the surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy. It was used to treat colon cancer or inflammation (proctosigmoiditis, proctitis, diverticulitis, etc.). Currently, its use is limited to emergency surgery when immediate anastomosis is not possible, or more rarely it is used palliatively in patients with colorectal tumours."
Diagram of Hartmann's Operation on the Sigma Colon
Sunnycd wrote:...I plan on calling my surgeon and make an appointment ASAP. I have questions! Any suggestions on what to ask (I have quite a few already...)
Green Tea wrote:Sunnycd wrote:...I plan on calling my surgeon and make an appointment ASAP. I have questions! Any suggestions on what to ask (I have quite a few already...)
Hi Sunnycd -
It's good that you are planinng to talk to your surgeon. This will give you a chance to review some areas that she never covered when you were first diagnosed.
Yes, I have some suggestions on what to ask, but I may have even more as time goes on. What would really help is to know when you need suggestions by so that I can plan on finalizing a list of suggestions in time for your meeting.
One thing I would ask the surgeon, for example, is how many centimeters of rectal stump still remain, because this will determine how difficult the re-connect operation will be and how much of the rectum will still be usable..
I would also suggest that you make an appointment with one of the pelvic health clinics in town, or with a proctologist. This is so that you can get a baseline measurement of your sphincter pressure using an ano-rectal manometer and find out just how much improvement you need to make before the the reversal operation takes place.
So, let us know how your appointment scheduling goes and whether this will be an in-person appointment or a telephone appointment.
Green Tea wrote:I have a question about your hospital. It has a patient portal where patients can log in and see some of their medical records.
Have you registered for this service? Do you know what kind of information you have access to?
Sunnycd wrote:... I will explain everything to you when I see you.” ... I like her confidence though, but it sounds like a wish and a prayer. I am hoping for the best but preparing for the worst.
Sunnycd wrote:...I called my surgeon to make an appointment to go over my original surgery, steps for reversal, complications, etc, but seems she will only be available to talk on June 22nd, which is like 2 weeks after my last chemo...
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