My previous blog discusses the day I had surgery and how I felt the first few days after.  In this blog I will try to explain what things were done to accomplish a total colectomy (removal of my entire large intestine).  Instead of having a general surgeon perform my surgery, I had a specialist known as a colorectal surgeon perform mine.  A colorectal surgeon specialized in this type of surgery.

The large intestine, or colon, is about 4-5 feet in length.  It begins where the small intestine ends, at the ileocecal valve.  Just after the large intestine starts is where the appendix is attached.  (So I guess I've had my appendix removed.)  The large intestine extends from the right lower quadrant of the abdomen up to about the rib cage, then across the belly and down.  It then goes over to the middle of the belly, and finally down and out.  The last few inches are actually anus, which is different tissue than the large intestines themselves.  

To accomplish the surgery I had, they created some small lap-sites (laparoscopy sites).  I think there were 3 of them.  Through these sites a camera was inserted and instruments were inserted to perform the surgery.  The doctors had to carefully disconnect the blood supply and connective tissue from the entire colon.  I assume that was done first.  Then they would have clamped and cut the large intestine at the beginning and end points.  To remove it, they made a transverse incision right above my pubis bone.  I refer to this as my c-section scar.  It's not quite as wide as a c-section scar would usually be, but it is in the right spot.  After the large intestine was removed then the next part of the surgery happened.

The next phase involved stapling the end of the small intestines (distal ileum) and then turning it into the shape of a J.  At the bottom of the J an opening was cut.  Then a stapling instrument would have been inserted to staple both sides of the J together.  Two rows of staples would have been done simultaneously, with the instrument slicing down the center.  Thus the J-Pouch was created.  This connection is also referred to as ileoanal anastomosis.  J-Pouch is a type of ileoanal reservoir.  The remaining opening of this J-Pouch was then stapled to the anus.  One part of this surgery remained.

Some surgeons consider the surgery basically finished as described above, but the surgeon I had isn't a risk taker.  He wanted to give the J-Pouch time to heal, without stool passing through it, to reduce the chance of serious infection.  Therefore a temporary diverting loop ileostomy was created.  In the right part of my belly, a little below the level of the belly-button the small intestine was pulled up through one of the holes which had previously been made.  This was not the end of the ileum, as that was now a J-Pouch at the end of the digestive tract.  It was more like the intestine was bent in half and pulled through the hole.  It was then cut partway through and sewn to my belly.  This created the opening through which stool would pass into an ostomy bag for the next several months.  This ileostomy had the appearance of a moist red/pink maraschino cherry with the skin off of it.  All of my incisions would have been sewn closed and an ostomy bag was applied to the newly created ileostomy.  

So what I woke up with after surgery was a c-section scar, a couple of small lap-sites and an ileostomy bag.

The day arrived for my visit with the colorectal surgeon, Dr. Sklow, at the University of Utah.  The University of Utah is a teaching hospital.  As such, you don't usually see just one doctor.  Usually several doctors at different levels of preparation visit with you.  I was first seen by a resident doctor, and then Dr. Sklow came in and visited with my wife and me.  My four years as an Air Force Medic had given me insight.  I knew what to look for in a doctor and I was very impressed by Dr. Sklow.  He asked the right types of questions.  He listened to me intently, waiting for my full response.  He thoroughly discussed the plan for surgery.  In addition he gave me a booklet about the j-pouch. 

He did have to do an exam I had never had done before.  The purpose of the exam was to help insure that I had ulcerative colitis and not Crohn's.  The exam involved putting a scope/speculum in the anus.  The doctor explained that ulcerative colitis would not be on the actual anus tissue, but Crohn's would be.  He further explained that the doctor from Idaho Falls, who diagnosed me with ulcerative colitis, had sent him a patient in the past with a diagnosis of ulcerative colitis, which was eventually proven to have Crohn's disease.  If this were crohn's disease, I would not be a candidate for surgery, as the disease would just return someplace else.  I understood the reason for the exam, but it was very uncomfortable.  This was at a point in my life when I had poor bowel control, and putting something in that area made me nervous, and was very uncomfortable.  Luckily the exam only lasted a few seconds. 

I was confirmed to have ulcerative colitis.  We further discussed the plan for surgery.  I was to have my entire large intestines removed.  He would then take the end of my small intestines, the distal ileum, and make a j-pouch.  This would be stapled to my anus.  Additionally he would bring part of the small intestines through the skin and create a temporary loop ileostomy.  An ileostomy is like a colostomy, except that it is from the ileum instead of the colon.  The plan was to have the ileostomy for 2.5 to 3 months while the anastomosis of the j-pouch to the anus had time to heal.  The surgery was being done in phases to reduce the risk of infection.  If the connection didn't heal right and began to leak into my gut, I could get really infected.  Sepsis and death are real possibilities when stool leaks inside of you.  The entire surgery was expected to last 6 to 8 hours.

I was excited.  When could he do the surgery?  I would gladly have gone in the next day.  They weren't able to get me scheduled until the end of February.  That was over a month away and that seemed like a really long time.  I spent the next month and a half, mostly just lying on the couch at home and running to the bathroom.  Such was my life now. 

Two days before the surgery my wife took me out to one last good dinner.  It would be awhile before I was able to eat real food.  We went to my favorite Mexican restaurant in Idaho Falls, Idaho.  I ate Mexican food and drank orchata until I was as stuffed as after Thanksgiving dinner.  The day before the surgery we went from Idaho to Utah and stayed with my sister in a suburb of Salt Lake City.  There I began one final bowel prep.

I drank the prep and then had to drink a gallon or more of a beverage of my choice.  I chose a pineapple flavored soda.  This was one of the few foods/drinks that still tasted good to me that was clear enough to drink for the prep.  Over 5 years have passed and I still do not enjoy pineapple soda as much as I used to.  I would recommend drinking something you can tolerate, but that isn't one of your favorites for all bowel preps.  Even though I began the prep in mid-afternoon I was up most of the night going to the bathroom.  By morning I felt famished.  I was used to feeling weak, and a night of bowel prep only made things worse.  Now it was off to the hospital.