On Monday I had my first meeting with Dr. Buie, my colorectal surgeon, in almost a year. As I detailed in a previous post, I booked this appointment after my latest round of chemo and the subsequent infection of my abscess that followed. We wanted to discuss options for a surgical solution to the problem of this recurring infection. While antibiotics seem to keep the worst of it at bay, it would be best if I could minimize the frequency and duration of the infectious episodes so that my body can concentrate on fighting the cancer. We came up with three possibilities for surgery that could meet our goals.
Option one is the least invasive and in the end, the one that we chose. It entails converting my loop ileostomy to a permanent ileostomy. As it stands now I have an intact intestinal tract but all my stool leaves my body from a loop of small bowel that comes to the surface at my stomach. The loop has a slit in it and the contents empty into a bag. The problem with this is that it is designed for people who will regain complete colon funtion and eventually have it reversed. In my case this might have happened early on but with the complications (abscess/drain issues) this will never happen for me. With a loop ileostomy, if the bag fills up, the pressure build up can force stool or gas into my large intestine and rectum. This, in turn, gets forced into my abscess carrying with it bacteria and causes infections. With a permanent ileostomy, it is presupposed that no stool or gas would enter the lower bowel or the abscess and hence the frequency of infection would decrease. The surgery is short and simple and would required minimal recovery time. The chance of adverse side effects or complications is minimal.
The second option would be to convert my temporary loop ileostomy to a permanent colostomy. This would require entering into the abdomen (big surgery) to bring a portion of the large intestine to the surface forming a colostomy. Essentially this has the same benefits as option one (no stool or gas passing into the lower colon/rectum/abscess) but is a more invasive surgery with a longer recovery time and a higher chance of adverse side effects or complications.
When I asked Dr Buie what he would do for someone in my situation that was completely healthy, he told me about option three. For this case he would do a highly invasive, complicated surgery in tandem with another colorectal surgeon. He would convert me to a permanent ileostomy (or colostomy - my choice) but remove all the remaining colon, most of the rectum, and all of the infected abscess tissue. This option holds the best chance of permanently removing the risk of infection from the abscess but it also carries the most risk. A surgery of this magnitude would entail an extensive recovery period in and out of the hospital. It also carries the most risk of damage to existing structures in the pelvis. The amount of scar tissue there would make it hard to separate the good tissues and nerves from the infected ones. It is very likely that this surgery would result in bladder and erectile dysfunction. The recovery from this surgery and it's likely side effects and complications would very likely interfere with my ability to do chemotherapy and would focus my body's energy on recovery rather than fighting the disease.
So after some discussion, Penny and I landed on option number one. It has the best risk/reward balance of them all. In addition to option one, during the surgery Dr. Buie would look at the abscess from the bottom end and attempt to see the connection between the rectum and abscess. If he can see it he would try to enlarge it so that the fluids in the abscess cavity can drain freely into the rectum. This flow would also serve to discourage bacteria in the rectum from entering the abscess.
Timing for the surgery would be pretty soon. I would have a sineogram this week or next and follow up with Dr. Buie in his clinic shortly after that. Then we could book surgery as soon as he gets OR time and get this thing done. I would guess at a four to six week time frame but that is just a guess. I'm feeling good now and am looking forward to getting this thing done!
