Adhesions and takedown surgery

[Tryagain]

Can anyone please advise me?
I had a temporary ( double barrel ) ileostomy formed 6 months ago after 20 cm of ileum and the caecum were removed and my sigmoid was repaired, where the Diseased ileum had stuck to it.
3 days after the operation I got really sick due to a partial blockage of the small bowel, which I was later told was caused by adhesions. I was drip fed and in hospital for 2 weeks. It got better without more surgery and I have been ok since, but stick to a low fibre diet and take a lot of loperamide for high output.
It took me a long time to get over the op mentally as well as physically and I have had problems with my joints since then, but, glad to say the last 5 weeks I have had loads more energy, and better mood.

Now I have been offered a date for my tAke down surgery, in 2 weeks time.
I had a sigmoidoscopy last week, the repair is healed but the scope couldn't get very far as the surgeon said the "distal sigmoid" is tethered. So I think that might mean its stuck because of more adhesions in that area too.

I am very worried about this operation, because I was so sick with the blockage last time and I am really worried that I now have bad adhesions which will make the surgery more difficult and risky and also means I get more adhesions!

My surgeon didn't mention adhesion before the first surgery so I was unaware of that risk. I have not been able to see him to properly discuss the risks with this second surgery. I have read quite a lot on line about adhesions which has not reassured me !! I feel like the surgeon will think I am making a fuss, and so I am nervous about asking him the questions I have.

I have loads of questions ! For eg, would it be better or worse adhesions wise to wait another 6 to 12 months for the takedown op ? Is there anything that I can ask be done to reduce the risk of more adhesions forming ?
I also have hypotrophic (? I think that's the word, it's pink and swollen looking ) midline scar which I think also shows that I am maybe prone to developing extra scar tissue and deep adhesions.

I never expected an ileostomy or complications such as adhesions so it was a big shock I am only just getting over. I just can't decide whether to go ahead with this second take down operation now or wait. I don't want to risk the adhesions getting worse meanwhile ( I read they solidify over time ) so that next year I find a reversal isn't even possible.

Has anyone had a similar experience or knows about these risks and what can be done to help reduce them please

Thanks for any help !
Tryagain

 

[Tryagain]

I forgot to add that the surgeon said the reversal will have to be through the original midline scar because of the adhesion problem, so I guess he's expecting it won't be straightforward !

 

[highlandsrock]

Hi Tryagain. I'm probably can't help a lot but I'll give you my support. I had virtually the same operation as you in October 2010 and the reversal almost three years ago this week. I was warned from the first time I met the surgeon that an ileostomy was a possibility but I don't remember adhesions ever being mentioned as a risk. I think I may now have developed them since the reversal. It would explain the annoying ache I've been getting in my side but it hasn't stopped me leading a normal life and walking 5 - 10km a day.

It's very easy to start assuming the worst when you do research into medical problems on the internet (a pet subject of mine - forums should carry health warnings!). Don't be nervous about asking your surgeon any questions that you might have. If it is worrying you then it will impact upon the way you approach the next operation at that is in nobody's interest. If you can't see your surgeon is there a specialist colorectal nurse or IBD helpline you can talk to?

My reversal operation was carried out through the incisions where the two ends of the ileostomy stuck out through. As the surgeon explained it "we reconnect the two ends, poke them back inside and sew you up. It's a much quicker, simpler operation than you've already had".

Hope that helps a little

 

[nogutsnoglory]

Any surgery comes with adhesions but your surgeon knows you have them and still feels confident in a takedown. I think you can take comfort in the fact that thru believe it should go well. Yes, you can develop adhesions from takedown too but all surgery comes with risk and in my opinion a reversal is worth those risks.

 

[Tryagain]

Thank you highlandsrock and nogutsnoglory. This surgery will be another big one as he has to open me up again due to the adhesions, but you are right, I really need to trust the surgeon who is prepared to do it. He is really good, in fact he just recently got an MBE ! I just would like to know whether he will use something like seprafilm this time, as I hear there are barriers and gels they can use etc. if not, do I wait until they start using these or find somewhere else to have it done? I really need to ask him those questions myself I suppose.
I know worrying is the worst thing to do but sooo hard not to. Mostly I just get on with things but this is really troubling me now. I have decided not to go googling about it again ! I can't help feeling like I need to try and do what I can to make the best outcome, but maybe I just need to accept it's all beyond my control, and think positive ,

How did you fare after the takedown highlandsrock ? As I have my large bowel intact I'm hoping it won't be too long before things settle down.

Thanks again for your help

 

[highlandsrock]

Sounds like a sensible move not to do too much Googling. When I was diagnosed with PSC one of the doctors actually said "don't look it up on the internet"! I did and then I understood her comment.

Have you tried emailing your surgeon with your concerns? When my reversal operation was cancelled due to low platelet count I emailed the surgeon directly to ask him to put me back on his list as I was actively sorting out the problem. It worked.

Since the reversal I've been on no Crohn's medication apart from two capsules of Loperamide a day. If you have time then look at www.crohnoid.com where I have recorded my experiences from the Ileostomy through reversal and a few "issues" (which may or may not be Crohn's related). There's a chapter list on the bottom right hand side.

 

[nogutsnoglory]

Anticipation is the worst for anxiety but Im happy you have this opportunity.

 

[Tryagain]

Thnks again to you both for your helpful replies . I am seeing the surgeon on Friday to discuss. And am worrying less now. Fingers crossed.

 

[mugsymagoos]

When you say "adhesions" do you mean scarring???

 

[vonfunk]

Adhesions are when two things that should not be attached (like sections of intestine) start growing together. In the case of intestinal adhesions, they can cause the bowels to narrow, twist and kink which can cause obstructions. They can happen in the healing process: post-surgery, injuries, bad flares, etc.