One consistent tip from researching j-pouch surgery was to select the most experienced surgeon you can find. I interviewed two local surgeons but decided after our consultations, that I may have to travel to find the right one. Although this automatically makes this process more difficult from a logistics standpoint, I am happy (so far) with my decision. My surgeon has performed almost 1,000 j-pouch procedures and is one of the main j-pouch surgeons at a top hospital in the US. People have traveled as far as Saudi Arabia to have him operate on them. His success rate is 99%.
The pre-op itinerary went a little something like this:
1.) Registration - confirmation of insurance (your insurance company will need to pre-approve surgery and this approval is initiated by the hospital, so I just received a letter in the mail a couple of weeks ago to let me know I was good to go), ID, and providing a copy of a living will.
2.) Lab time - standard blood and urine tests
3.) Meeting with the surgeon - the purpose of this meeting is to go over any remaining questions and sign paperwork. My first surgery is scheduled on Monday and is considered the "bigger" of the two - total proctocolectomy with internal jpouch creation and temporary diverting loop ileostomy. After this surgery, and several follow-ups, I will have the reversal or takedown surgery scheduled. Likely the surgeries are three months apart to allow my jpouch to heal. Since I mulled over this surgery for YEARS, talked to numerous j-pouchers and surgeons and GI doctors, met with this specific surgeon already two times and researched this procedure for hours on end, I really didn't have any remaining questions for him. I was ready.
4.) Meeting with the wound,ostomy, and continence nurse - my meeting with the WOC nurse was awesome. Patient, kind, and down-to-earth. She showed me the standard supplies: barrier ring, wafer, ostomy bag, clip. She had me lift my shirt and pull down my shorts a bit so she could choose my stoma site. Before she started drawing, I stood, sat, and laid down so she could choose the best place for it. Then she marked my stomach, just below and to the side of my belly button, with two large black dots - one on my right (your left if you were facing me), where my stoma would likely go, and one on the left, "just in case".
We also talked about the loop ileostomy and how it's different from an end ileostomy. She also warned me that I will have a small plastic rod that will help prop up the loop, but this rod will only be in place for a few days after surgery. I will see her the day after my surgery so she can perform my first appliance change.
5.) Pre-op evaluation - since I am fortunate enough to not have any other major health issues and I'm relatively young, this was a quick evaluation. The nurse practitioner took my vital signs, listened to my heart and lungs, talked to me about my medical history, and asked me about my current medications. Oh yeah, current meds...I am on NO meds right now. Since I was in quasi-remission when I scheduled my surgery and in pretty good shape, my surgeon asked that I stop all biologics and immunomodulator medications for 6-8 weeks prior to surgery. This of course means that for the past 6 weeks I have been in a flare and my hemoglobin is low, but other than that, I checked out just fine.
Next up: my last ever bowel prep tomorrow and surgery on Monday!