August 5, 2026 • 32 mins
Medical breakthroughs don't always make headlines. Sometimes they're the innovations that quietly transform lives.
In this episode of MedStar Health DocTalk, host Debra Schindler talks with colorectal surgeon Dr. Sherief Shawki to discuss the K-pouch (Kock pouch), a highly specialized surgical procedure that offers a life-changing alternative for some patients living with an ileostomy or experiencing complications from a J-pouch.
Dr. Shawki explains:
- What a K-pouch is and how it works
- The difference between a J-pouch and a K-pouch
- Who may be a candidate for this specialized surgery
- Why so few surgeons perform K-pouch procedures
- What patients can expect during recovery
- How the procedure can restore independence and quality of life
You'll also hear how advances in surgical expertise are helping patients from across the country, including those who have exhausted other treatment options; find hope through one of the nation's few dedicated K-pouch programs.
If you or someone you know is living with an ileostomy, has experienced J-pouch complications, or is exploring reconstructive colorectal surgery options, this conversation provides valuable insight from one of the country's experienced K-pouch surgeons.
To schedule a consultation with Dr. Sherief Shawki, call 443-777-2475.
Learn more about colorectal surgery at MedStar Health: MedStarHealth.org
Subscribe to MedStar Health DocTalk for conversations with physician experts covering the latest advances in medicine, surgery, and patient care.
For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.
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Episode Transcript
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(00:01):
Comprehensive, relevant,and insightful conversations about health
and medicine happen hereon MedStar Health Doc Talk.
These are real conversationswith physician experts from
around the largesthealthcare system in the
Maryland DC region.
Medical breakthroughs don'talways make headlines.
Sometimes they're advancesthat quietly transform people's lives,
(00:24):
helping them regain theirindependence, their confidence,
and even a sense of normalcy.
Today, we're talking aboutone of those advancements.
It's called the K-Pouch,a highly specialized surgical option
that relatively few people have heard ofand even fewer surgeons perform.
Yet for some patients who nolonger have a functioning colon
(00:45):
and require an ileostomy,it can return them
to a quality life.
I'm happy to have Dr.
Sherief Shawki back with us.
He's a colorectal surgeonat MedStar Health,
and he's here to tell usabout what the K-Pouch is,
how it works, and who may benefit from it.
I'm your host, Debra Schindler.
Welcome to DocTalk. Dr.
Shawki, thanks for being here.
(01:05):
Thank you very much, Deborah.
It's always a pleasureto be with you on DocTalk
and talk with our audienceabout what do we have
and what we offer at MedStar.
Today's topic is very, very good topicand interesting to many
of our patient population,the colorectal surgery.
And I'm looking forward fora great discussion with you.
It can be a difficulttopic for many to discuss,
(01:26):
maybe even to think aboutbecause it really is very personal.
Bowel function, ostomies,incontinence are topics
many people don't feelcomfortable to discuss.
So before we get into the surgery,can you explain why someone
might need their colonand rectum removed in the first place?
Excellent question. Thereare certain diseases
(01:47):
that affect the colon and the rectum.
And despite the advancementin medical treatment
and medical management,still a decent amount
of patient population were requiredto remove all their colon and rectum.
And these patients are deemedto live with an end ileostomy
with external bag forthe rest of their lives.
(02:10):
The big portion of this isinflammatory bowel disease,
which specifically is thechronic ulcerative colitis.
That's a disease that affects the colonand the rectum with
significant inflammation.
Patients have diarrhea, bloodydiarrhea, abdominal cramps,
temperature, and they basically,their life is centered
(02:31):
around their colony rectum aswell as finding a bathroom.
A very compromised lifestyle, it soundsLike.
Significantly impaired quality of life.
With the advancement in medical treatment,these people need significant medication
that suppress theinflammation that's caused
by the inflammatory process.
(02:52):
And with the medical advancements,it's called biologic medications.
Still 15 to 20% ofpatients will not respond
to medical treatment, will continueto experience these symptoms
either for prolonged periodof time or for repetitive
episodes known as flare-ups,which requires admission to hospitals
and disruption of lifestyle,disruption of family life
(03:16):
and of course the sequela of all of this.
These patients are deemedrefractory to medical treatment.
Therefore, they get referredto colorectal surgeons
to remove the colon and the rectum.
By the time patients come tosee you, they've often been
through years living withserious colorectal disease.
(03:37):
And they've seen many specialists.
They've probably been on many medicationsthat are now failing.
At what point does the conversationshift from managing the
disease to considering surgery?
When they become refractoryto the medical treatment
experiencing more flare-ups,more inflammatory signs
and symptoms, more diarrheathan normal, then this mean
(04:00):
that they are not reallyresponding to the medical treatment.
And when their quality of lifeis significantly impaired,
this is when we say,listen, surgery is not,
does not mean that you are failing.
Surgery is one of the option.
And simply speaking, removing the colonand the rectum results
in cure because as I saidbefore, this disease affect
the colon and the rectum only.
(04:23):
Once the colon and therectum is removed, most
of the patients, they arecured from the ulcerative
colitis that they had.
But that would require either an ileostomyor a colostomy bag, right?
Is that the first step?
Very good follow up. Yes, thatwill require an ileostomy,
external bag, until we get them readyto use their natural pathway
(04:44):
of elimination, their anus,by using something called ileal J-pouch.
So you can reconnect that?
Excellent point. So while weare getting the patient body
physiology rebalancedafter the significant
disruption of the dis -of the physiology with the disease,
(05:05):
we give them temporary endileostomy.
Then we connect theBowel - Which is, let's, for anybody
who doesn't understand what that is,a temporary ileostomy is?
We connect the ileum, the lastportion of the small bowel
to their skin thatempties in a bag attached
to their abdominal wall.
Okay. And that resultsinto spontaneous passage of
(05:27):
stool content as well as gas content.
That's known as ileostomy.
Okay.
Also known as a bag.
And sometimes it's known as colostomy.
Although the location ofthat stoma is different,
but I'm providing thedifferent names that I,
I hear people talking about.
Sure. Now, in order topreserve the natural pathway
(05:50):
of the elimination, whichusing the anal canal,
we create a reservoirfrom that last portion
of the small bowel called the ileum.
That reservoir is created by foldingtwo loops next to each other.
Cut the wall between them.
Now we have front wall and back wall.
(06:11):
Basically, we create an atriumthat can accumulate stool
instead of the nat - the, thenormal rectum that we had.
We connect that reservoiror atrium to the top of the inner canal.
Therefore, the patient canuse their natural pathway
of elimination after we removetheir colon and rectum out.
(06:34):
And that's the J pouch.
That is the ileal J pouchbecause it looks like the
letter J, like the candy. And what's thatPouch made out of?
Is it natural body part?
Very good question. It is madefrom the natural body part,
which is the last portionof the small bowel,
known as ileum.
Okay. And then the rectal muscles stillwork in the same way?
(06:56):
It's ima - it's aprerequisite for patients
to have ileal J pouch,to have a functioning
sphincter muscle. Deborah?
So that's the first reconstructive option.
I think one of the biggestquestions listeners may have is
if there's no ostomy bag,how do they empty it from the J pouch?
But it sounds like they're just goingto the bathroom like normal.
(07:18):
Correct. And if I may add,Deborah, they usually go,
the stool consistency issoft, applesauce-like,
and the frequency is more.
So in an, in an ideal situation,they go to the bathroom,
eliminate naturally as normal,about four to six times.
It can go up to eight to 10 times.
They are also expectedto have some seepage.
(07:41):
And because of the disruptionof the mechanism of cont -
of continence, they mayhave night leakage as well.
With a J-pouch?
With a J pouch, yes.
But that's occur in a verysmall patient population,
but we always explainand set the patient
expectations for those outcomes.
(08:03):
So I guess like any surgery,there can be setbacks
or things might not go as well as planned.
Or with time, something changes.
And the consideration thenbecomes this K pouch named
after a doctor named Koch with a K.
Correct.
Tell me what the K pouch is,how it differs from the J pouch,
(08:27):
and why is it so specialized?
Why is it so unheard of really?
Very good. So if apatient is not candidate
for a J pouch to use theirnatural elimination pathway,
example, a patient with disruptedanal sphincter mechanism
that will not allow themto control the elimination
(08:48):
of the stool, they will beincontinent all the time.
They cannot live like this.
A patient that they hadsome sort of malignancy or,
or inflammatory bowel disease associatedpre-malignant lesions
in their lower rectumthat we cannot keep any
of this part and we have to take it out.
These patients are doomed tohave a permanent ileostomy,
(09:09):
as we said before, wherethey poop in a bag attached
to their abdominal wall.
One more level up. What if apatient had an ileal J pouch,
but they experiencesignificant complication
that they cannot retaintheir ileal J pouch anymore?
Then these patients aredoomed to remove the J pouch
and revert to the permanent external bag,as we call it ileostomy.
(09:34):
Which is not ideal for many reasons.
For - It's hanging offyour body, skin infections.
For many reason. So this,although we look at the
end ileostomy at its lifesaving for the patient.
Sure,Sure. But let's assume there is a young,
motivated female who is in a relationshipand she doesn't want to be
wearing a bag all the time.
(09:57):
Let's think of another young lawyer who,who is having meeting,
and this bag is basicallyadding some emotional
and social stress, especiallywith the spontaneous passage
of stool or noises coming outfrom the bag in the middle
of important meetingor in a social dinner.
These patients arecandidates for the K pouch.
(10:20):
Before I say what is a K pouch,I want to highlight Deborah
that we say ileal J pouchbecause the configuration
looks like the letter J.
When we say a K-pouch, weare using the initial of Dr.
Nils Cook who devised the pouch.
It, it does, the pouch doesnot look like a letter K. Okay.
Yeah. Now what is a K-pouch?
(10:45):
So we call it a continentileostomy, which means
it's a reservoir that accumulatesand retains stool under
the abdominal wall.
And it has a continence mechanismthat provides the person
the control on when to eliminate.
(11:07):
And instead of having a bag on theoutside, they don't have to wear a bag
and they don't have to have asto - a, a small, a piece of,
they don't have to wear a bagand they don't have to have a small piece
of their bowel stickingabove their skin level
(11:27):
because this type of stomais flush with the skin.
So nobody would ever knowthat they have stoma there
and they cover it with a bandaid.
That's it. Now the lastquestion you asked was
how does the patient eliminateand how the patient has
control and elimination?
We have a con - a continencemechanism that we build into
(11:50):
that reservoir by telescopingthe bowel in itself.
This results into a one way valve.
So we use the natural patient bowel.
We create the reservoir,which is the atrium.
We create the continencemechanism, which is the,
the telescoping of the bowel in itself,creating one way valve.
(12:14):
The pouch, the K-pouch livesunder the front abdominal wall.
And it connects to the skinwith a very short segment
of bowel and it stops at the skin.
The one way valve does notallow the spontaneous excretion
of the bowel content inthe K-pouch reservoir.
So no leakage.
No leakage.
(12:36):
And gas? Gas Can Escape?
No gas. No Gas can come out.
Does that then become very uncomfortable?
The patient will knowwhen they want to empty.
When they have to go and release.
Yes.
Okay.
And at that point, how tobypass that one way valve is
by inserting a tube the size of your pinkyin that stoma.
(12:58):
And it goes in like astraw in a juice box.
It go through the stoma,through the valve,
into the reservoir, and thenthe fluid stool comes out.
And then they take thetube out and they're done.
I assume there's somethingon the other end of
that tube, the catheter that they -100%.
There are different ways.
(13:19):
Some people sit on the toilet seat. Okay.
And put the other end of thetube into the toilet bowl.
Some people stand the front of the sinkand they put a collecting jar
that they collect the stool inand then they throw it
into the toilet bowl.
There are different ways.
Now how much does that pouch hold?
How frequently do they haveto use a cath to drain it?
(13:43):
Is that the right word? Drain it?
Yes.
Empty It?
Empty it or drain it,that's the right word.
Usually we tell them to,when the pouch is mature,
we tell them to empty the pouchor drain the pouch four
to six times a day.
And then we tell them beforeyou sleep, empty the pouch.
And if you wake up in themiddle of the night to go
(14:04):
to the bathroom, alsotry to empty the pouch.
We like to keep thepouch on the empty side,
but it does not, the, the keyAdebra is it does not disrupt
their daily activity.
If you are having a meetingand instead of the bag is
getting filled whileyou are in the meeting
and you can feel it andyou get stressed out,
(14:25):
you can actually empty your pouch.
And you know for thenext hour or two hours
or three hours, you are good.
You are not worriedabout your elimination.
And you can focus on the activity on hand.
A far more controlled scenario it seemsLike.
100%. And that's why we call it continentileostomy, because it provides
control for the personto empty and eliminate their
(14:48):
bowel content or their stool.
Now when someone has this K-pouchand the pouch becomes full,
do they feel a sensationas we do when we need to use the bathroom?
Yes. It's not the same sensation.
But they feel - But it's equivalent.
So they know.
They know. Yes.
It sounds ideal. It actuallysounds pretty ideal.
(15:12):
Why not just jump to theK-pouch and skip the J pouch?
This is a very, very good question.
So I'm going to try toexplain for the audience in a,
in an, in an organized way.
The initial proposal for peoplewith permanent end
ileostomy with external bagwas the K-pouch, but the
procedure is very intricate.
(15:33):
And historically, there is bad repetitionthat the complication of the K
pouch was very high, going upto 50, 60%.
But that was old days.
Subsequently, the J-pouch came to lifeand the J-pouch preserved
the natural pathway.
And honestly, if I ha, if Ichoose which one, I will choose
(15:55):
to use a J-pouch to keep my anusand to keep using my natural pathway.
This is what I'm used to as a human being.
Sure. Okay.
But if I am not candidate for a J-pouch,for whatever reason of what
we talked about earlier,my sphincter is not working well.
I am incontinent. I am leaking.
I develop significantcomplications of the J-pouch.
(16:17):
I have severe refractory,non-responsive pouchitis,
which means severeinflammation in the pouch.
And that also express itself.
Same thing like ulcerative colitis.
Inflammation, cramps, bloodydiarrhea, lack of control
because of the, the, the forceful,you know, passage of mucus.
Then I am doomed to havepermanent ileostomy.
(16:40):
And me personally, I woulddefinitely try the continental
ileostomy, which is the K-pouch,before I wear a permanent
ileostomy forever.
Now in fairness, like anysurgery, this isn't perfect.
What are some of therisks or complications?
Same complications like any other surgery.
Infection, bleeding, leaks, and fistulas.
(17:01):
What does this mean? The suture linesthat I create this pouch from can
come undone, can fall apart.
And this will result into leakingof fecal matter into the abdominal cavity.
This is an emergency.
And sometimes we have to takethe patient back to the OR
to clean their abdomen and put drains.
And the risk, as I saidbefore, the risk of these
(17:22):
complications are about 15%,which is way better than
historically labeled as 50 to 60%because we know how to do it better.
We have done so many of it,and we understand the
intricacy of the valve creationand the pouch creation.
Therefore, our complicationrate significantly dropped
(17:43):
compared to the 70s and the 80s.
As a surgeon, is it avery challenging surgery
to perform technically?
I mean, because it's not done everywhere.
That's true. And thank youfor bringing this point.
It's a very intricateprocedure to create a K-pouch.
(18:03):
As we know from othersurgical specialties,
and in our specialtiesparticularly, high volume surgeons
and high volume centers,they have better outcomes.
The more complex the surgery is,the fewer centers you have.
Therefore, in the country, in the USA,there are about maybe
(18:24):
four or five centers.
And maybe there are four orfive surgeons who are capable
of taking care of thosepatients and their complications
and how to fix any issuesthat happen in the future.
And we are very proud to share thatwe have our very own K-pouch
program at MedStar FranklinSquare Hospital, that we are
(18:46):
now receiving patients from allover the country who
either have had a K-pouchand they need to fix their complications,
or patients who areinterested to learn about it
and to have it if they haveissues with their J-pouches
or they don't want J-pouch.
Anybody getting a K-pouchhas to have a J-pouch first.
(19:07):
Does it ever happen thatyou would perform a surgery
to build a K-pouch?
Deborah, your questionstoday as every time, spot on.
I, I, I really congratulateyou. Thank you.
The majority of thepatients who are deemed
to have their colonand rectum removed, the standard
of care is the ileal Jpouch to keep their anus
(19:29):
and their natural pathway of elimination.
A very, very short patient population,either they are done using their
natural elimination pathwaybecause they are done with the diarrhea.
They are done with themultiple bowel movement.
And I've had this actually,many patients come to me from the get go.
(19:49):
An engineer and a businessmanthat travels all over the world.
He came and he said, "I knowI am, I am, I'm a candidate
for ilio J pouch, but I don'twant to use my anus anymore.
I am done. I read about the K-pouch.
I know you're one of the surgeonswho do this in the country.
I want to get K-pouch from the get go."The other person is an
engineer father of three.
And he said same thing, "I am done.
(20:11):
I need a K-pouch and my, I did my homeworkand I am ready." And some
patients are actually candidatefor the K pouch, for the
J-pouch, and they want a J-pouch,but they have disrupted
anal sphincter mechanism.
So if you connect their small boweland the J-pouch with the anus,
they will leak stool all,all day long, and then eventually
they will have irritationand they will be sitting
(20:35):
on fire basically.
Okay.
So these patients, when they come to meand I told them, "You are a
candidate for the J-pouch,but this is the expected
function." And I never push.
But if they tell me, "Is thereanother option?" I present
to them the option of theK-pouch, AKA continent ileostomy.
And almost more than90% of those patients,
(20:56):
they end up having thecontinent ileostomy. And
I guess if you don'thave enough colon left,
maybe too many resections,that would be a good option for patients.
Same concept applies.
If you don't have much colon left,but you can use your anus, then you go
to the ileal J-pouch pathway.
If the ileal J pouch pathwayis not going to work for either
(21:21):
patient preference or sphincter functionor J-pouch related
complications, then the K-pouchor the contact ostomy becomes, in my mind,
the second best option.
So where is the, theK-pouch actually located?
If I'm looking at somebody's belly,where would the opening be?
Center right? Center left?
(21:42):
It's actually very far low in their belly.
So they can wear shorts andnobody can see anything.
Oh, Really? That is even -It's just above the groin.
It's that low. Wow. Okay.
How would you want a patientto ask you if you've had experience?
How many surgeries do youthink it takes for a surgeon
(22:04):
to claim that he is veryproficient with this surgery?
I read about a case where awoman had the K-patch created
and had to go in for a revisionbecause she was passing fecal
matter out of her vagina.
And that sounded like a catastrophe to me.
I mean, how does that happen?
(22:25):
The higher complexityof the surgery, the higher this takes.
And I'm known to be veryhonest with my patients
and with my audience.
I've had complications.
This is not my patient,by the way, but I myself
- Yeah, no. It definitelyWasn't.
I myself had my, myshare of complications,
but I sit down with my patientsand I tell them, "This is
(22:46):
what we're going to be going through.
This is the expectation.
These are the potentialcomplications." And in my recent
experience before Ijoined MedStar, out of 105
cases of a K-pouch,this is a very high volume in
the whole world, by the way.
I guess we had like the10, 15% complication,
(23:08):
which is very much equivalentto the complication of the ileal J pouch.
A patient who is interestedin the K-pouch, goes to a,
a surgeon at whatever hospital,what do they ask them?
A GI surgeon or a colorectal surgeonand ask them, "Do you perform a K-pouch?
I'm interested in having this surgery."What should their
(23:30):
expectation be for someonewho was proficient or
skilled to perform that?
Should it be five surgeriesbehind them? 10 surgeries?
So this is a very good question.
I cannot give an exact number.
So I'm going to say in myopinion, in my humble opinion,
having done 20 cases should be enoughto overtake something like this.
(23:57):
And the reason I'm saying this is this.
This, that's why, this needs a program.
That's why it is not a surgeon effort.
To do the K-pouch, Deborah,it requires a surgeon.
It requires OR team,surgical team who knows how
to help me do the surgery.
It requires the postoperativenursing team to know how
(24:20):
to take care of this patient.
It requires the regularfloor nurses to know how
to take care of the postoperativecare of this patient.
It requires the stoma nurses to goand do the education
required for those patientsand the care required for those patients.
This program is not surgeon dependent.
(24:42):
It's a big team.
So if the surgeon have done hundred cases,but they don't have the program -
The support behind them.
I would, I would say don'tdo it in that center. Okay.
And that's why we say it's a program.
To specifically answer this question,surgeon experience starts
after 20 to 30 cases.
(25:02):
Wow. However, the program aroundthe K-pouch is of utmost importance.
Who's an ideal candidate for this?
The patient who cannot usetheir anus, the patient
who has a complication with ileal J-pouchand they can, they want
the J-pouch to be excised.
And the patients who have end ileostomythat they are not happy
(25:25):
with their quality of life.
These are the patient that could comeand ask about their
candidacy for a K-pouch.
And who wouldn't be a good candidate?
Number one, enemy.
This type of procedure is excessfat either around the bowel
or under the skin.
So visceral obesity whenthe fat is around the organs
(25:47):
and central obesity when the fat ishigh in the subcutaneous
portion, the, under the skin,these affect the functional
outcomes of a K-pouchand make it at higher risk of failure.
So I don't create K-pouch for peoplewho have either high visceral obesity
or high subcutaneous fat.
What about people whohave Crohn's disease?
(26:10):
This is another contraindicationbecause we suspect
that Crohn's disease willactivate in the terms
of fistulization, likecreating abnormal connections
between the pouch and thesurrounding structures.
So therefore that take,that take the Crohn's
disease off the list.
Let's talk about the surgeryitself. How long is it?
It didn't seem that longwhen I was in there with you.
(26:32):
The surgery usually takes asshort as three, four hours.
As long as seven, eight, nine hours.
It depends upon identifying the anatomy.
When anatomy is straightforward,then three, four hours.
It takes lots of suturing.
And to build the valve,it takes some time.
And then to seat thepouch inside the abdomen,
(26:54):
to have it seated appropriately,and to create the, the
stoma for it, to be ableto intubate without kinking.
So these all takes mentalthought processing from me
when I'm doing the surgery.
And I don't rush. So straightforwardcase, about three, four hours.
Now, if I have to doadhesions, take adhesions down,
(27:15):
identify anatomy, it all depends onhow long it will take
me to define anatomy.
And, and you mean byadhesions if the person had
had previous surgeriesAnd maybe had some Scar tissue?
If the patient had scar tissuefrom previous surgeries, yes.
Okay. And the valve thatyou're talking about
that you just mentioned, the building, isthat built also out of their own anatomy?
(27:37):
Correct.
So there's nothing -Or external.
Implants or anything like that?
Okay. Correct.
What's the recovery like?
How long are they in the,in the hospital typically?
Between seven days and 10 days.
Once they get home from the hospital,can they eat? Are they in pain?
Before they leave thehospital, we make sure
that they are eating andthe, the tube, which stays
(27:59):
inside the pouch for four weeks.
The tube is producingstool and they come back
and see us in four to fiveweeks where we take the tube out
and they start intubatingthemselves on their own.
So until then, is there still anileostomy when they leave?
There is no. So they, theyalways have ileostomy.
The ileostomy, as I said before,it is flush with the skin.
(28:22):
So nothing is protruding.
They don't wear a bag.
Oh, I see.
But we leave the tube, the catheterthat they drain their pouch.
We leave it in place.
I see.
Until the pouch suture lines heal,which takes about weeks
plus or, plus or minus.
This is when they come backand we take that tube out.
(28:43):
Okay. So They Have a drain tube.
Yes. Maybe a bubble orsomething is connected to that.
And then they start intubating themselves.
And what has been thefeedback from your patients?
How do they respond to having that?
What's their lives like in yourexperience in talking with them?
Thank you for asking this question.
So I want to categorize them by patientswho had ileal J-pouch that did not work,
(29:05):
and they had a K-pouch.
I want to start withthis group of patients.
Everybody says thispouch, I mean the K-pouch,
gave me my life back.
And those who had a J-pouch,like our recent patient
we were talking about,she had good day with the J-pouch
and then she developed complications.
And we tried to keep her J-pouchin place, but we couldn't.
I converted her J-pouch to a K-pouch,and she is very happy with her life now.
(29:32):
Wonderful.
I have another patient whodid not have a good pra, good function
or good outcome with her J-pouch.
I converted her J-Pouch to a K-pouch.
She is doing hiking with her dog.
She's doing fishing tripswith her significant other.
She is traveling. Theperson I told you about,
the businessman who didopted out of the J-pouch
(29:53):
and he wanted a K-pouch.
This person travels to Kenya, travelsto the Asia with his K-pouch.
Right. And he intubates before he goesto the, on the flight.
Right. And maybe he'll needto intubate while he's on the flight.
So it's, he's functional.
Can he swim with it?
Yes.
Hot tubs.
Hot tubs, swimming, golfing,intimacy, you name it.
(30:14):
That is amazing.
And there is no bag inbetween you and whatever you're doing.
For someone listening todaywho may feel they've run out
of options, what wouldyou like them to know?
If you have an ileal Jpouch that is failing
and you are doomed to have permanent bag,or if you have a permanent
bag, permanent ileostomy,and you are not happy with
(30:35):
your current quality of life,I would say please reach out to us
and let's discuss yourcandidacy for a K-pouch
because this can change your life.
Do you love what you do?
100%.
People's lives are being changed.
You have no idea when you see a patientbefore the surgery,
(30:57):
when their facial expressionscarry an anxiety, carry fear
and discomfort and loss of quality.
And then when you see the real smileafter a successful surgery,
this is invaluable.
Sure. Well, having recently met oneof your young patients, a young mom,
I came away thinking this podcast isn'tso much about a surgical procedure.
(31:21):
It's about hope, it's ingenuity,and seriously, it's about
medical craftsmanship.
100%.
Any final thoughts for listeners?
If you or somebody you knowthat you believe would benefit
from a continent ileostomyor K-pouch, particularly
those who are not happywith their J-pouch function,
those who are carrying a bagand they are not happy with
it, I would say either come,ask us or direct your loved ones to us,
(31:48):
and we are more than happyto answer their questions.
Thank you for all that you do, Dr. Shaki.
We've been talking withcolorectal surgeon, Dr.
Sherief Shawki at MedStarFranklin Square Medical
Center in Baltimore.
And thank you for sharing your expertisewith us here on Doctor.
Thank you very much, Deborah.
It's always a pleasureand looking forward for our next one.
(32:08):
On the J-Pouch.
On the J-Pouch.
If you'd like to consult with Dr.
Shawki about the K-pouchor a J-Pouch, call 443-777-2475.
Comprehensive, relevant,and insightful conversations about health
and medicine happen hereon MedStar Health Doc Talk.
These are real conversationswith physician experts from
around the largesthealthcare system in the
Maryland DC region.
Medical breakthroughs don'talways make headlines.
Sometimes they're advancesthat quietly transform people's lives,
(00:24):
helping them regain theirindependence, their confidence,
and even a sense of normalcy.
Today, we're talking aboutone of those advancements.
It's called the K-Pouch,a highly specialized surgical option
that relatively few people have heard ofand even fewer surgeons perform.
Yet for some patients who nolonger have a functioning colon
(00:45):
and require an ileostomy,it can return them
to a quality life.
I'm happy to have Dr.
Sherief Shawki back with us.
He's a colorectal surgeonat MedStar Health,
and he's here to tell usabout what the K-Pouch is,
how it works, and who may benefit from it.
I'm your host, Debra Schindler.
Welcome to DocTalk. Dr.
Shawki, thanks for being here.
(01:05):
Thank you very much, Deborah.
It's always a pleasureto be with you on DocTalk
and talk with our audienceabout what do we have
and what we offer at MedStar.
Today's topic is very, very good topicand interesting to many
of our patient population,the colorectal surgery.
And I'm looking forward fora great discussion with you.
It can be a difficulttopic for many to discuss,
(01:26):
maybe even to think aboutbecause it really is very personal.
Bowel function, ostomies,incontinence are topics
many people don't feelcomfortable to discuss.
So before we get into the surgery,can you explain why someone
might need their colonand rectum removed in the first place?
Excellent question. Thereare certain diseases
(01:47):
that affect the colon and the rectum.
And despite the advancementin medical treatment
and medical management,still a decent amount
of patient population were requiredto remove all their colon and rectum.
And these patients are deemedto live with an end ileostomy
with external bag forthe rest of their lives.
(02:10):
The big portion of this isinflammatory bowel disease,
which specifically is thechronic ulcerative colitis.
That's a disease that affects the colonand the rectum with
significant inflammation.
Patients have diarrhea, bloodydiarrhea, abdominal cramps,
temperature, and they basically,their life is centered
(02:31):
around their colony rectum aswell as finding a bathroom.
A very compromised lifestyle, it soundsLike.
Significantly impaired quality of life.
With the advancement in medical treatment,these people need significant medication
that suppress theinflammation that's caused
by the inflammatory process.
(02:52):
And with the medical advancements,it's called biologic medications.
Still 15 to 20% ofpatients will not respond
to medical treatment, will continueto experience these symptoms
either for prolonged periodof time or for repetitive
episodes known as flare-ups,which requires admission to hospitals
and disruption of lifestyle,disruption of family life
(03:16):
and of course the sequela of all of this.
These patients are deemedrefractory to medical treatment.
Therefore, they get referredto colorectal surgeons
to remove the colon and the rectum.
By the time patients come tosee you, they've often been
through years living withserious colorectal disease.
(03:37):
And they've seen many specialists.
They've probably been on many medicationsthat are now failing.
At what point does the conversationshift from managing the
disease to considering surgery?
When they become refractoryto the medical treatment
experiencing more flare-ups,more inflammatory signs
and symptoms, more diarrheathan normal, then this mean
(04:00):
that they are not reallyresponding to the medical treatment.
And when their quality of lifeis significantly impaired,
this is when we say,listen, surgery is not,
does not mean that you are failing.
Surgery is one of the option.
And simply speaking, removing the colonand the rectum results
in cure because as I saidbefore, this disease affect
the colon and the rectum only.
(04:23):
Once the colon and therectum is removed, most
of the patients, they arecured from the ulcerative
colitis that they had.
But that would require either an ileostomyor a colostomy bag, right?
Is that the first step?
Very good follow up. Yes, thatwill require an ileostomy,
external bag, until we get them readyto use their natural pathway
(04:44):
of elimination, their anus,by using something called ileal J-pouch.
So you can reconnect that?
Excellent point. So while weare getting the patient body
physiology rebalancedafter the significant
disruption of the dis -of the physiology with the disease,
(05:05):
we give them temporary endileostomy.
Then we connect theBowel - Which is, let's, for anybody
who doesn't understand what that is,a temporary ileostomy is?
We connect the ileum, the lastportion of the small bowel
to their skin thatempties in a bag attached
to their abdominal wall.
Okay. And that resultsinto spontaneous passage of
(05:27):
stool content as well as gas content.
That's known as ileostomy.
Okay.
Also known as a bag.
And sometimes it's known as colostomy.
Although the location ofthat stoma is different,
but I'm providing thedifferent names that I,
I hear people talking about.
Sure. Now, in order topreserve the natural pathway
(05:50):
of the elimination, whichusing the anal canal,
we create a reservoirfrom that last portion
of the small bowel called the ileum.
That reservoir is created by foldingtwo loops next to each other.
Cut the wall between them.
Now we have front wall and back wall.
(06:11):
Basically, we create an atriumthat can accumulate stool
instead of the nat - the, thenormal rectum that we had.
We connect that reservoiror atrium to the top of the inner canal.
Therefore, the patient canuse their natural pathway
of elimination after we removetheir colon and rectum out.
(06:34):
And that's the J pouch.
That is the ileal J pouchbecause it looks like the
letter J, like the candy. And what's thatPouch made out of?
Is it natural body part?
Very good question. It is madefrom the natural body part,
which is the last portionof the small bowel,
known as ileum.
Okay. And then the rectal muscles stillwork in the same way?
(06:56):
It's ima - it's aprerequisite for patients
to have ileal J pouch,to have a functioning
sphincter muscle. Deborah?
So that's the first reconstructive option.
I think one of the biggestquestions listeners may have is
if there's no ostomy bag,how do they empty it from the J pouch?
But it sounds like they're just goingto the bathroom like normal.
(07:18):
Correct. And if I may add,Deborah, they usually go,
the stool consistency issoft, applesauce-like,
and the frequency is more.
So in an, in an ideal situation,they go to the bathroom,
eliminate naturally as normal,about four to six times.
It can go up to eight to 10 times.
They are also expectedto have some seepage.
(07:41):
And because of the disruptionof the mechanism of cont -
of continence, they mayhave night leakage as well.
With a J-pouch?
With a J pouch, yes.
But that's occur in a verysmall patient population,
but we always explainand set the patient
expectations for those outcomes.
(08:03):
So I guess like any surgery,there can be setbacks
or things might not go as well as planned.
Or with time, something changes.
And the consideration thenbecomes this K pouch named
after a doctor named Koch with a K.
Correct.
Tell me what the K pouch is,how it differs from the J pouch,
(08:27):
and why is it so specialized?
Why is it so unheard of really?
Very good. So if apatient is not candidate
for a J pouch to use theirnatural elimination pathway,
example, a patient with disruptedanal sphincter mechanism
that will not allow themto control the elimination
(08:48):
of the stool, they will beincontinent all the time.
They cannot live like this.
A patient that they hadsome sort of malignancy or,
or inflammatory bowel disease associatedpre-malignant lesions
in their lower rectumthat we cannot keep any
of this part and we have to take it out.
These patients are doomed tohave a permanent ileostomy,
(09:09):
as we said before, wherethey poop in a bag attached
to their abdominal wall.
One more level up. What if apatient had an ileal J pouch,
but they experiencesignificant complication
that they cannot retaintheir ileal J pouch anymore?
Then these patients aredoomed to remove the J pouch
and revert to the permanent external bag,as we call it ileostomy.
(09:34):
Which is not ideal for many reasons.
For - It's hanging offyour body, skin infections.
For many reason. So this,although we look at the
end ileostomy at its lifesaving for the patient.
Sure,Sure. But let's assume there is a young,
motivated female who is in a relationshipand she doesn't want to be
wearing a bag all the time.
(09:57):
Let's think of another young lawyer who,who is having meeting,
and this bag is basicallyadding some emotional
and social stress, especiallywith the spontaneous passage
of stool or noises coming outfrom the bag in the middle
of important meetingor in a social dinner.
These patients arecandidates for the K pouch.
(10:20):
Before I say what is a K pouch,I want to highlight Deborah
that we say ileal J pouchbecause the configuration
looks like the letter J.
When we say a K-pouch, weare using the initial of Dr.
Nils Cook who devised the pouch.
It, it does, the pouch doesnot look like a letter K. Okay.
Yeah. Now what is a K-pouch?
(10:45):
So we call it a continentileostomy, which means
it's a reservoir that accumulatesand retains stool under
the abdominal wall.
And it has a continence mechanismthat provides the person
the control on when to eliminate.
(11:07):
And instead of having a bag on theoutside, they don't have to wear a bag
and they don't have to have asto - a, a small, a piece of,
they don't have to wear a bagand they don't have to have a small piece
of their bowel stickingabove their skin level
(11:27):
because this type of stomais flush with the skin.
So nobody would ever knowthat they have stoma there
and they cover it with a bandaid.
That's it. Now the lastquestion you asked was
how does the patient eliminateand how the patient has
control and elimination?
We have a con - a continencemechanism that we build into
(11:50):
that reservoir by telescopingthe bowel in itself.
This results into a one way valve.
So we use the natural patient bowel.
We create the reservoir,which is the atrium.
We create the continencemechanism, which is the,
the telescoping of the bowel in itself,creating one way valve.
(12:14):
The pouch, the K-pouch livesunder the front abdominal wall.
And it connects to the skinwith a very short segment
of bowel and it stops at the skin.
The one way valve does notallow the spontaneous excretion
of the bowel content inthe K-pouch reservoir.
So no leakage.
No leakage.
(12:36):
And gas? Gas Can Escape?
No gas. No Gas can come out.
Does that then become very uncomfortable?
The patient will knowwhen they want to empty.
When they have to go and release.
Yes.
Okay.
And at that point, how tobypass that one way valve is
by inserting a tube the size of your pinkyin that stoma.
(12:58):
And it goes in like astraw in a juice box.
It go through the stoma,through the valve,
into the reservoir, and thenthe fluid stool comes out.
And then they take thetube out and they're done.
I assume there's somethingon the other end of
that tube, the catheter that they -100%.
There are different ways.
(13:19):
Some people sit on the toilet seat. Okay.
And put the other end of thetube into the toilet bowl.
Some people stand the front of the sinkand they put a collecting jar
that they collect the stool inand then they throw it
into the toilet bowl.
There are different ways.
Now how much does that pouch hold?
How frequently do they haveto use a cath to drain it?
(13:43):
Is that the right word? Drain it?
Yes.
Empty It?
Empty it or drain it,that's the right word.
Usually we tell them to,when the pouch is mature,
we tell them to empty the pouchor drain the pouch four
to six times a day.
And then we tell them beforeyou sleep, empty the pouch.
And if you wake up in themiddle of the night to go
(14:04):
to the bathroom, alsotry to empty the pouch.
We like to keep thepouch on the empty side,
but it does not, the, the keyAdebra is it does not disrupt
their daily activity.
If you are having a meetingand instead of the bag is
getting filled whileyou are in the meeting
and you can feel it andyou get stressed out,
(14:25):
you can actually empty your pouch.
And you know for thenext hour or two hours
or three hours, you are good.
You are not worriedabout your elimination.
And you can focus on the activity on hand.
A far more controlled scenario it seemsLike.
100%. And that's why we call it continentileostomy, because it provides
control for the personto empty and eliminate their
(14:48):
bowel content or their stool.
Now when someone has this K-pouchand the pouch becomes full,
do they feel a sensationas we do when we need to use the bathroom?
Yes. It's not the same sensation.
But they feel - But it's equivalent.
So they know.
They know. Yes.
It sounds ideal. It actuallysounds pretty ideal.
(15:12):
Why not just jump to theK-pouch and skip the J pouch?
This is a very, very good question.
So I'm going to try toexplain for the audience in a,
in an, in an organized way.
The initial proposal for peoplewith permanent end
ileostomy with external bagwas the K-pouch, but the
procedure is very intricate.
(15:33):
And historically, there is bad repetitionthat the complication of the K
pouch was very high, going upto 50, 60%.
But that was old days.
Subsequently, the J-pouch came to lifeand the J-pouch preserved
the natural pathway.
And honestly, if I ha, if Ichoose which one, I will choose
(15:55):
to use a J-pouch to keep my anusand to keep using my natural pathway.
This is what I'm used to as a human being.
Sure. Okay.
But if I am not candidate for a J-pouch,for whatever reason of what
we talked about earlier,my sphincter is not working well.
I am incontinent. I am leaking.
I develop significantcomplications of the J-pouch.
(16:17):
I have severe refractory,non-responsive pouchitis,
which means severeinflammation in the pouch.
And that also express itself.
Same thing like ulcerative colitis.
Inflammation, cramps, bloodydiarrhea, lack of control
because of the, the, the forceful,you know, passage of mucus.
Then I am doomed to havepermanent ileostomy.
(16:40):
And me personally, I woulddefinitely try the continental
ileostomy, which is the K-pouch,before I wear a permanent
ileostomy forever.
Now in fairness, like anysurgery, this isn't perfect.
What are some of therisks or complications?
Same complications like any other surgery.
Infection, bleeding, leaks, and fistulas.
(17:01):
What does this mean? The suture linesthat I create this pouch from can
come undone, can fall apart.
And this will result into leakingof fecal matter into the abdominal cavity.
This is an emergency.
And sometimes we have to takethe patient back to the OR
to clean their abdomen and put drains.
And the risk, as I saidbefore, the risk of these
(17:22):
complications are about 15%,which is way better than
historically labeled as 50 to 60%because we know how to do it better.
We have done so many of it,and we understand the
intricacy of the valve creationand the pouch creation.
Therefore, our complicationrate significantly dropped
(17:43):
compared to the 70s and the 80s.
As a surgeon, is it avery challenging surgery
to perform technically?
I mean, because it's not done everywhere.
That's true. And thank youfor bringing this point.
It's a very intricateprocedure to create a K-pouch.
(18:03):
As we know from othersurgical specialties,
and in our specialtiesparticularly, high volume surgeons
and high volume centers,they have better outcomes.
The more complex the surgery is,the fewer centers you have.
Therefore, in the country, in the USA,there are about maybe
(18:24):
four or five centers.
And maybe there are four orfive surgeons who are capable
of taking care of thosepatients and their complications
and how to fix any issuesthat happen in the future.
And we are very proud to share thatwe have our very own K-pouch
program at MedStar FranklinSquare Hospital, that we are
(18:46):
now receiving patients from allover the country who
either have had a K-pouchand they need to fix their complications,
or patients who areinterested to learn about it
and to have it if they haveissues with their J-pouches
or they don't want J-pouch.
Anybody getting a K-pouchhas to have a J-pouch first.
(19:07):
Does it ever happen thatyou would perform a surgery
to build a K-pouch?
Deborah, your questionstoday as every time, spot on.
I, I, I really congratulateyou. Thank you.
The majority of thepatients who are deemed
to have their colonand rectum removed, the standard
of care is the ileal Jpouch to keep their anus
(19:29):
and their natural pathway of elimination.
A very, very short patient population,either they are done using their
natural elimination pathwaybecause they are done with the diarrhea.
They are done with themultiple bowel movement.
And I've had this actually,many patients come to me from the get go.
(19:49):
An engineer and a businessmanthat travels all over the world.
He came and he said, "I knowI am, I am, I'm a candidate
for ilio J pouch, but I don'twant to use my anus anymore.
I am done. I read about the K-pouch.
I know you're one of the surgeonswho do this in the country.
I want to get K-pouch from the get go."The other person is an
engineer father of three.
And he said same thing, "I am done.
(20:11):
I need a K-pouch and my, I did my homeworkand I am ready." And some
patients are actually candidatefor the K pouch, for the
J-pouch, and they want a J-pouch,but they have disrupted
anal sphincter mechanism.
So if you connect their small boweland the J-pouch with the anus,
they will leak stool all,all day long, and then eventually
they will have irritationand they will be sitting
(20:35):
on fire basically.
Okay.
So these patients, when they come to meand I told them, "You are a
candidate for the J-pouch,but this is the expected
function." And I never push.
But if they tell me, "Is thereanother option?" I present
to them the option of theK-pouch, AKA continent ileostomy.
And almost more than90% of those patients,
(20:56):
they end up having thecontinent ileostomy. And
I guess if you don'thave enough colon left,
maybe too many resections,that would be a good option for patients.
Same concept applies.
If you don't have much colon left,but you can use your anus, then you go
to the ileal J-pouch pathway.
If the ileal J pouch pathwayis not going to work for either
(21:21):
patient preference or sphincter functionor J-pouch related
complications, then the K-pouchor the contact ostomy becomes, in my mind,
the second best option.
So where is the, theK-pouch actually located?
If I'm looking at somebody's belly,where would the opening be?
Center right? Center left?
(21:42):
It's actually very far low in their belly.
So they can wear shorts andnobody can see anything.
Oh, Really? That is even -It's just above the groin.
It's that low. Wow. Okay.
How would you want a patientto ask you if you've had experience?
How many surgeries do youthink it takes for a surgeon
(22:04):
to claim that he is veryproficient with this surgery?
I read about a case where awoman had the K-patch created
and had to go in for a revisionbecause she was passing fecal
matter out of her vagina.
And that sounded like a catastrophe to me.
I mean, how does that happen?
(22:25):
The higher complexityof the surgery, the higher this takes.
And I'm known to be veryhonest with my patients
and with my audience.
I've had complications.
This is not my patient,by the way, but I myself
- Yeah, no. It definitelyWasn't.
I myself had my, myshare of complications,
but I sit down with my patientsand I tell them, "This is
(22:46):
what we're going to be going through.
This is the expectation.
These are the potentialcomplications." And in my recent
experience before Ijoined MedStar, out of 105
cases of a K-pouch,this is a very high volume in
the whole world, by the way.
I guess we had like the10, 15% complication,
(23:08):
which is very much equivalentto the complication of the ileal J pouch.
A patient who is interestedin the K-pouch, goes to a,
a surgeon at whatever hospital,what do they ask them?
A GI surgeon or a colorectal surgeonand ask them, "Do you perform a K-pouch?
I'm interested in having this surgery."What should their
(23:30):
expectation be for someonewho was proficient or
skilled to perform that?
Should it be five surgeriesbehind them? 10 surgeries?
So this is a very good question.
I cannot give an exact number.
So I'm going to say in myopinion, in my humble opinion,
having done 20 cases should be enoughto overtake something like this.
(23:57):
And the reason I'm saying this is this.
This, that's why, this needs a program.
That's why it is not a surgeon effort.
To do the K-pouch, Deborah,it requires a surgeon.
It requires OR team,surgical team who knows how
to help me do the surgery.
It requires the postoperativenursing team to know how
(24:20):
to take care of this patient.
It requires the regularfloor nurses to know how
to take care of the postoperativecare of this patient.
It requires the stoma nurses to goand do the education
required for those patientsand the care required for those patients.
This program is not surgeon dependent.
(24:42):
It's a big team.
So if the surgeon have done hundred cases,but they don't have the program -
The support behind them.
I would, I would say don'tdo it in that center. Okay.
And that's why we say it's a program.
To specifically answer this question,surgeon experience starts
after 20 to 30 cases.
(25:02):
Wow. However, the program aroundthe K-pouch is of utmost importance.
Who's an ideal candidate for this?
The patient who cannot usetheir anus, the patient
who has a complication with ileal J-pouchand they can, they want
the J-pouch to be excised.
And the patients who have end ileostomythat they are not happy
(25:25):
with their quality of life.
These are the patient that could comeand ask about their
candidacy for a K-pouch.
And who wouldn't be a good candidate?
Number one, enemy.
This type of procedure is excessfat either around the bowel
or under the skin.
So visceral obesity whenthe fat is around the organs
(25:47):
and central obesity when the fat ishigh in the subcutaneous
portion, the, under the skin,these affect the functional
outcomes of a K-pouchand make it at higher risk of failure.
So I don't create K-pouch for peoplewho have either high visceral obesity
or high subcutaneous fat.
What about people whohave Crohn's disease?
(26:10):
This is another contraindicationbecause we suspect
that Crohn's disease willactivate in the terms
of fistulization, likecreating abnormal connections
between the pouch and thesurrounding structures.
So therefore that take,that take the Crohn's
disease off the list.
Let's talk about the surgeryitself. How long is it?
It didn't seem that longwhen I was in there with you.
(26:32):
The surgery usually takes asshort as three, four hours.
As long as seven, eight, nine hours.
It depends upon identifying the anatomy.
When anatomy is straightforward,then three, four hours.
It takes lots of suturing.
And to build the valve,it takes some time.
And then to seat thepouch inside the abdomen,
(26:54):
to have it seated appropriately,and to create the, the
stoma for it, to be ableto intubate without kinking.
So these all takes mentalthought processing from me
when I'm doing the surgery.
And I don't rush. So straightforwardcase, about three, four hours.
Now, if I have to doadhesions, take adhesions down,
(27:15):
identify anatomy, it all depends onhow long it will take
me to define anatomy.
And, and you mean byadhesions if the person had
had previous surgeriesAnd maybe had some Scar tissue?
If the patient had scar tissuefrom previous surgeries, yes.
Okay. And the valve thatyou're talking about
that you just mentioned, the building, isthat built also out of their own anatomy?
(27:37):
Correct.
So there's nothing -Or external.
Implants or anything like that?
Okay. Correct.
What's the recovery like?
How long are they in the,in the hospital typically?
Between seven days and 10 days.
Once they get home from the hospital,can they eat? Are they in pain?
Before they leave thehospital, we make sure
that they are eating andthe, the tube, which stays
(27:59):
inside the pouch for four weeks.
The tube is producingstool and they come back
and see us in four to fiveweeks where we take the tube out
and they start intubatingthemselves on their own.
So until then, is there still anileostomy when they leave?
There is no. So they, theyalways have ileostomy.
The ileostomy, as I said before,it is flush with the skin.
(28:22):
So nothing is protruding.
They don't wear a bag.
Oh, I see.
But we leave the tube, the catheterthat they drain their pouch.
We leave it in place.
I see.
Until the pouch suture lines heal,which takes about weeks
plus or, plus or minus.
This is when they come backand we take that tube out.
(28:43):
Okay. So They Have a drain tube.
Yes. Maybe a bubble orsomething is connected to that.
And then they start intubating themselves.
And what has been thefeedback from your patients?
How do they respond to having that?
What's their lives like in yourexperience in talking with them?
Thank you for asking this question.
So I want to categorize them by patientswho had ileal J-pouch that did not work,
(29:05):
and they had a K-pouch.
I want to start withthis group of patients.
Everybody says thispouch, I mean the K-pouch,
gave me my life back.
And those who had a J-pouch,like our recent patient
we were talking about,she had good day with the J-pouch
and then she developed complications.
And we tried to keep her J-pouchin place, but we couldn't.
I converted her J-pouch to a K-pouch,and she is very happy with her life now.
(29:32):
Wonderful.
I have another patient whodid not have a good pra, good function
or good outcome with her J-pouch.
I converted her J-Pouch to a K-pouch.
She is doing hiking with her dog.
She's doing fishing tripswith her significant other.
She is traveling. Theperson I told you about,
the businessman who didopted out of the J-pouch
(29:53):
and he wanted a K-pouch.
This person travels to Kenya, travelsto the Asia with his K-pouch.
Right. And he intubates before he goesto the, on the flight.
Right. And maybe he'll needto intubate while he's on the flight.
So it's, he's functional.
Can he swim with it?
Yes.
Hot tubs.
Hot tubs, swimming, golfing,intimacy, you name it.
(30:14):
That is amazing.
And there is no bag inbetween you and whatever you're doing.
For someone listening todaywho may feel they've run out
of options, what wouldyou like them to know?
If you have an ileal Jpouch that is failing
and you are doomed to have permanent bag,or if you have a permanent
bag, permanent ileostomy,and you are not happy with
(30:35):
your current quality of life,I would say please reach out to us
and let's discuss yourcandidacy for a K-pouch
because this can change your life.
Do you love what you do?
100%.
People's lives are being changed.
You have no idea when you see a patientbefore the surgery,
(30:57):
when their facial expressionscarry an anxiety, carry fear
and discomfort and loss of quality.
And then when you see the real smileafter a successful surgery,
this is invaluable.
Sure. Well, having recently met oneof your young patients, a young mom,
I came away thinking this podcast isn'tso much about a surgical procedure.
(31:21):
It's about hope, it's ingenuity,and seriously, it's about
medical craftsmanship.
100%.
Any final thoughts for listeners?
If you or somebody you knowthat you believe would benefit
from a continent ileostomyor K-pouch, particularly
those who are not happywith their J-pouch function,
those who are carrying a bagand they are not happy with
it, I would say either come,ask us or direct your loved ones to us,
(31:48):
and we are more than happyto answer their questions.
Thank you for all that you do, Dr. Shaki.
We've been talking withcolorectal surgeon, Dr.
Sherief Shawki at MedStarFranklin Square Medical
Center in Baltimore.
And thank you for sharing your expertisewith us here on Doctor.
Thank you very much, Deborah.
It's always a pleasureand looking forward for our next one.
(32:08):
On the J-Pouch.
On the J-Pouch.
If you'd like to consult with Dr.
Shawki about the K-pouchor a J-Pouch, call 443-777-2475.
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