• Welcome to Crohn's Forum, a support group for people with all forms of IBD. While this community is not a substitute for doctor's advice and we cannot treat or diagnose, we find being able to communicate with others who have IBD is invaluable as we navigate our struggles and celebrate our successes. We invite you to join us.

Surgeons decisions?

does a surgeon have the final say as to the outcome of surgery when he open you up for a resection? and instead of waking up with a resection you wake up with a stoma instead? hoping next week to get this cleared up as i would like to know for certain that if i go for surgery i would rather it be on my terms if possible, as in yes, go for the resection , but if you are going to leave me with a stoma, just leave everything in situ and stitch me back up, have searched for answers on the net but found nothing relative
thanks, george.


Super Moderator
It is the surgeons responsibilty to ensure that you have been given informed consent. As a part of that consent they should discuss what the possible complications and outcomes may be, it is at this point they should explain to you what they expect to find and if it is different to what is expected what they may do, e.g. stoma. You do have a right, based on what you are told, to refuse consent to a certain procedure being performed.

You may say something like...if a stoma appears to be imminent I do not want the surgery to proceed. You are to finish what you are doing, close, send me back to the ward and then discuss with me what was found and what my options are. I will then make a decision as to how I will proceed.

Dusty. xxx
thanks for that dusty cat, thats just what i was hoping for,as one dr gave me the impression that one "in there" the surgeon had the final say,that was the reason ive walked out of emergency surgery twice last year because of not knowing the outcome and the surgeon telling me that id be left with a stoma
once again, thanks, george.
The surgical decision making "at the time" tends to be based on what is found at laparotomy. Sometimes the extent of the disease they find, or the blood supply to the areas involved means they feel forming a stoma is the safest option. (Joining up poorly perfused or seriously inflamed bowel is asking for more problems)
In my experience (and I work in operating theatres), the decisions are based on optimal safety and adequate function

thanks ellie, the area thats troublesome to me is the site of a right hemicolectomy, done in 2003, and it keeps narrowing, this is the area i want removed, so to stop the pain and regular throwing up , but i get the feeling that, as its the nhs in the uk that its a case of whip it all out and get ya of the books kinda thing, lol


Super Moderator
This is where is clear and precise communication is paramount.

Ellie's comments are accurate when complications have been discussed and you have provided informed consent.

A stoma was a possibility for my son, as it is for most Crohn's patients because you never truly know what will confront the surgeon when he gets in there, but we gave informed consent for this to be done if the need arose.

My daughter had emergency surgery and what they thought was going to be a simple laparotomy and appendectomy, she was undiagnosed at the time, turned out to be an absolute battle field when they got in there and I had consented to a laparotomy and appendectomy only, no other scenarios had been discussed. I was called up to theatre and the situation was explained and I gave verbal consent for a right hemicolectomy. Even if they hadn't called me up I had no issue with it because it was either that or she died. There will always be situations where a surgeon is left with few choices and so has to decide on the spot. Decisions made in these situations are never done lightly.

You are in a situation of having elective surgery. You have time on your side and you have time to discuss your options and outcomes with your surgeon. Regardless of what is said, at the end of the day you have the right to refuse treatment as suggested by any doctor and they have no choice but to respect that right. With that though is they then have the right not to oversee your care.

In your case hopefully you will find a surgeon who will do as you ask. They should in most cases have a pretty good idea as soon as they get in there what the outcome will be. My son went from there being a very high chance of needing a stoma to it not even being mentioned at pre op, I raised it, when we were able to stabilise him and delay surgery for 3 months.

Dusty. xxx


Super Moderator
gmm, do you mind if I ask why you don't want a stoma?

I only ask because at this point in time you have control over the situation and on face value it would seem a stoma is highly unlikely. The narrowing will only worsen over time as inflammation comes and goes and you will then find yourself in a situation that is no longer in your control...that being obstruction and/or rupture...and then your choices would be emergency surgery or death. Good lord, I hope that doesn't come across as trying to scare you! :eek2:

Dusty. xxx
heya dusty cat, im on pred only at the mo and at a 20mg per day dose, was at 4 times that when the narowing was at its worst,at the lower dose when tapering down i had about 6 weeks of near normality when i got down to the 40 mg so stuck at that til i was to see the consultant again, but i was "forgotten" lol, that was back in may, when he did tell me, we will get you with a bag yet, lol,to me its a case of not wanting one because its not needed , just one area thats affecting me, and because theres a small spot at the lower end of the large bowel, he said that that cant be cut out either or left there if the were to do a resection because the lower area would burst, yet ive being passing stuff as if ive been eating cement dust with every meal and breaking wind like a trumpet fanfare, in fact goin out of my way to eat beans, mushy peas etc, as for ending up with a stoma im not the type to put up with the cons of having one, this is why i want to get things ready for the next appointment next week as to see if they will or wont cut out the narrowing at the hemicolectomy ares or if i have to go to another nhs hospital 80 odd miles away
thanks, george.
had my appointment late this afternoon , and what a difference,been told to taper the pred down 1 mg per fortnight, and hopefully in 4 months, after a scope, surgery , im not looking forward to it though lol, surgery to take out the two areas at each end of the large bowel, instead of what i was told before of losing the lot,got to say its kinda perked me up a bit, so its all down to how i react to the pred taper, here's hoping.
Hi George

Before any operation you have to sign a consent form so you could caveat it to refuse to have a stoma but is that really a good idea? Your surgeon will try to avoid giving you a stoma if at all possible as they know that nobody would choose to have one unless absolutely necessary. But you need trust that they know what they are doing and are doing the best for recovery. If you don't have that confidence then find another surgeon!

I've been through this whole experience and probably had the same worries as yourself. My surgeon warned me that depending upon what he found once he had opened me up I could end up with a stoma to take the pressure of the large colon and give it a chance to heal. When I woke up in recovery the first thing one of the house surgeons did was apologise that I now had a stoma but explained it was the best clinical solution. I think the thought of a stoma is much worse than actually having and coping with one. The alternative, which must be a lot worse, is that your digestive system doesn't heal properly and you probably end up under the knife again.
heya highlandsrock
yeah thats what i was told at first, that they cant rejoin the area at the end of the large bowel and take out the area at the site of the previous hemicolectomy, because of pressure on the lower area, but now it seems possible somehow, and leaves me with most of the large bowel i got left thats working,but at least i know i wont wake up with a stoma as agreed with the consultant, this was the reason i walked out of emergency surgery twice last year, i dont mind not eating anything for a slightly longer period after surgery like this as the last time i was about 4 days before getting "sloppy" foods for the first time
Like others mentioned you have the right to refuse any treatment. Myself personally I do not except blood transfusions and I make sure that the dr knows that before any procedure. I have a durable power of attorney with 2 people to contact for alternatives to a blood transfusion. I am having surgery in the morning and told them absolutely no blood but they can use the cell salvage (basically a vacuum that takes in the blood i'm losing clean it and then they can put it back) Studies have proven that people who do not get transfusions during surgery heals fast and have less complications. When the dr know that they cant just slice you open and dont care about blood loss, it forces them to take extra care while doing the surgery.

The same principle might apply to your situation. If the dr know that you refuse to get a stoma they will not just go in there chopping and removing possible good areas. they are going to do their best to preserve as much of your good parts as they can.

I know that this may not make sense to some people but do what you think is best for yourself. I wish you the best and I hope that your surgery turns out well.
thanks , hope the same goes for yourself there, a quick recovery, yep im kinda glad i got something to aim for nowjust the pred tapering and a 4 month wait,hopefully, lol
When I had my surgery 2 years ago I was informed of the possibility that I might end up with a stoma. We knew I had a mess in there.There was a fistula,a couple feet of inflamed bowel, and a section of bowel that had been folded into an accordian. I was told it would most likely not result in a stoma, but the possibility was there I would need one.Because I trusted my surgeon to do what its in my best interest I consented to allow him to do whatever he deemed necessary.

I had open surgery.I knew this going in as laparotomy was not an option for me. I did not end up with a stoma. If I had, it would have been ok because my surgery saved my life.I was so obstructed a pea could have blocked me completely.

The surgeon is not going to do a stoma unless it is necessary.They know it is not the desired outcome.however it would be better than reattaching inflamed tissues.
well, while waiting for the surgery in feb ish, i ended up with a large abscess and fistula on the transverse colon , in between the two areas of prior disease and hemicolectomy site, so basically told that its impossible to do a "rejoin" a stoma is my only option, ended up with a drain on the abscess , been in about a week now, and as soon as it started draining i was feeling the gut rumble and starting to get hungry again, so it seems this is the area that has been brewing and causing all the hassle for the last few years maybe, am thinking the other two areas are having not much effect on me at all now, so hopefully get the drain out tomorrow, and make sure if poss that a stoma isnt my final option