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Ileo-Pouch Anal Anastomosis Guide
The Second Surgery (closure of the ileostomy)
When you are feeling well and are off all medications, the temporary ileostomy can be closed. This is the second stage of the process. Usually it is done six to eight weeks after your first procedure.
Preparing for Surgery
Several tests take place to determine your physical readiness for the closure of your ileostomy. First, you will have an X-ray of your new pouch, called a pouch-o-gram, to make sure it is well healed and has no leaks. This usually takes place the day before surgery. The pouch-o-gram is done in the hospital and takes about an hour. We will review it with you, answer any questions, and inform you as to whether you are ready for the ileostomy closure.
If you are ready for the closure, you will then undergo your preoperative lab tests, which include blood and urine tests, chest X-ray and an EKG. There is no pre-operative bowel preparation required, but you will be instructed not to eat or drink after midnight.
The closure surgery will take place in the morning and takes about
45 minutes to complete. Usually, a small incision around the ileostomy
is all that is necessary to free it up, oversew it and drop it back
into the abdomen. In about one out of seven patients, however, there
is extensive scarring in the abdomen that requires reopening of
the main incision to free up adhesions before the ileostomy can
be safely closed.
Following the surgery, you can anticipate good pain control during
the first few days. As outlined earlier, there are various methods
for controlling pain. These will be discussed with you prior to
surgery. They are also described on page 15.
As with the first surgery, you will have an I.V. in place to provide you with necessary calories, fluid, and electrolytes. You will also have a catheter to drain your urine. Both the I.V. and catheter help ensure that you are getting adequate fluid.
Your job will be to exercise your lungs with the spirometer and
to walk as much as possible. Both of these activities will help
to maintain your muscles and energy levels, and help prevent complications.
We will usually offer you a clear liquid diet on the second postoperative
day. If you tolerate it, you will be advanced to a regular diet.
After five to six days, when you are on a regular diet, you are
passing stool and all drains are removed, you will be permitted
to go home.
You will be given oral pain medicines to take home. You also may be given Lomotil or Imodium to slow your stool output, and a fiber supplement, i.e. Metamucil, to bulk your stool. If your hemoglobin level is low, you will go home with iron pills.
Once home, the best advice we can give you is to listen to your body. There are no diet restrictions, but you may find that some foods disturb your body. If some foods cause cramping or excessive gas, you should avoid them for several days and try them again later.
Activities should be limited. You should not drive a car until you are off all pain medications and you can move about freely. You should avoid lifting anything weighing more than 10 pounds or any other activities that cause you discomfort. Generally, your body will tell you when you are ready to do more. We would hope that after six weeks you will return to normal activities, but many patients find they are able to do most of their activities well in advance of this time.
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