I had Secondary Sigmoid Colon SRS with PAI

[SpiralCream]

There isn't as much information out there about this surgery, so I thought I'd share about mine.  I am now about a week post-op from sigmoid colon revision surgery at PAI, with Dr Burin.

Background: my first SRS was with Dr Chettawut.  I think he did a good job, and I've been pretty happy with the aesthetics.  Everything was fine during my recovery in Bangkok, but unfortunately several weeks after I returned home I had a complication.  To make a long story short, my internal skin graft failed, deep inside.  I struggled with bleeding, discharge, and pain.  I've had to wear maxi pads all day, every day, ever since.  And I permanently lost depth from 6" to 3".  Because of all these problems, I decided to get sigmoid colon surgery.  Not just to restore depth, but also to remove and replace the failed skin graft tissue that had become a source of such pain. 

When I had my pre-op consultation with Dr Burin, he was very patient as he explained all the benefits and risks and also dispelled some myths that I had believed to be true.  He was and has been very calm and patient with me the entire process, with a kind smile.  Communicating with him has been effortless.  His English is excellent, maybe even better than Dr Chet.

Pre-op preparation was similar to my first SRS with Chet.  I was required to do 3 days of a clear liquid diet.  But unlike my first SRS, I could not drink soda (because it could cause gas).  In my first SRS, I think I had to take the Swiff laxative just once, the night before.  But this time, I had to take it twice - the night before, and also two nights before.

My surgery was done at Phyathai Hospital in Bangkok.  I checked into the hospital the night before and got settled into my private hospital room, where I would spend the standard 7 days post-op recovering for this surgery.  I slept in the hospital room overnight.  The morning of the surgery, a nurse woke me up and did 3 enemas on me to clear my bowels.  Each time, she used a liter of saline solution and pumped all of it in!  It was very unpleasant.  Even after the third enema, my 'poop' still wasn't clear, so we did it 2 more times for a total of 5 times.

I will write more later...

[AnonyMs]

I'm curious why you didn't go with Dr Chett for the sigmoid colon revision surgery?

[SpiralCream]

I'm curious why you didn't go with Dr Chett for the sigmoid colon revision surgery?

I did consider going to him, but based on what little research I could find online, I felt like PAI had more experience with sigmoid colon surgery than Dr Chet.  PAI told me that they do about 3 sigmoid colon surgeries for every 10 regular SRS surgeries.  When I asked Chet, he didn't give me a number.  In fact I couldn't find a single story online from anyone who talked about their sigmoid colon revision with Chet (not that there's a ton of accounts of sigmoid colon surgeries at all, but at least there were some from PAI).  I wanted to go to the surgeon/team with the most experience with this particular surgery.  I also felt like for this surgery, I wanted it done in a full service hospital, rather than Chet's private clinic.  And although it wasn't a factor in my decision, PAI's cost for sigmoid colon revision was several thousand dollars less than what Dr Chet's office quoted me.

[warlockmaker]

I an a PAI girl and they did a fantastic surgery using 3 surgeons. Dr Sutin, Dr Preecha and Dr Sirichai with GRS, BA and  FFS all in one session. I am a fan. Hope all comes out well and do keep us in touch.

[SpiralCream]

Thank you, warlockmaker.  Hearing about your positive experiences with PAI was one of the reasons I chose them for my sigmoid colon revision.  Like you, I had more than one surgery at the same session.  I didn't do FFS at the same time (already had it done), but I did decide to do a breast augmentation at the same time as my sigmoid colon surgery.  While I was making arrangements, I asked if it was safe to do both, and PAI told me they said it would be possible, but that Dr Burin would need to examine me first.  He cleared me for both after my consultation.

So, for the first 3 days post-op in the hospital, I could not eat or drink anything while my bowel was healing.  I was not even allowed to drink water.  Combine that with the day of surgery itself, and it was 4 days total of not drinking any water.  My mouth and throat were sooo dry.  They told me about this before surgery and that it's standard recovery procedure, so it wasn't unexpected.  But still it was really, really hard.  They had an IV line connected to me to give me nutrients during this time.

As for the pain, wow!  It has been really intense.  The pain from my first SRS was really not that bad.  Most of the time it was just a low level pain.  But the pain from this sigmoid colon surgery is really sharp and debilitating in many ways.  It affects the lower abdominal muscles, and you use those muscles for everything.  Simply getting in and out of bed is a struggle, even now at 10 days post-op.  This makes getting into position to dilate a real challenge.  The usual pain meds that worked so well for me in my previous surgeries aren't enough to make the pain go away.

[Samanthaburgess]

Hi, thanks for sharing your story and hope your recovery is going ok. I'm also looking into secondary sigmoid colon with PAI so its been great to hear your experience.

With the pain did you get plenty of morphine in hospital? (I know that sounds like a junkie question, lol) i'm just asking cos when i went through my SRS 15 years ago, morphine was the only thing that got me through the pain. Did Dr Burin do any cosmetic revision for you?

As your 10 days post-op are you in the hotel or still at the hospital? If your at the hotel, is it far from PAI? Sorry about all the questions. Hope your recovery keeps on getting better and it'd be great to hear an update.

Sam x

[SpiralCream]

Yes they gave me a morphine drip at the hospital through my IV line.  The first few days of recovery were especially painful and I asked them to increase the amount of morphine, which they did.  After several days they tried to give me a different pain killer (I don't remember what it was).  It worked, but it made me feel nauseous.  So I asked them to put me back on morphine and they did.  They were very helpful and accomodating in my pain management.  (Now that I am back at my hotel, I am taking Arcoxia (etoricoxib), Tramadol, and Paracetamol for pain)

I was scheduled to be discharged from the hospital after 7 days, but I told them that I didn't feel strong enough to go to my hotel yet.  I came to Bangkok for this surgery by myself.  If I had a friend or family traveling with me to help me at my hotel, then maybe it would have been ok to be discharged at that time.  But since I was alone, I didn't feel I had the strength to take care of myself yet.  So I asked to stay another day in the hospital.  And maybe another day after that, and so on, until I felt well enough.  I told this to Dr Burin during his daily visit to my hospital room, and he told Bune (one of the patient coordinators at PAI; he is so friendly and helpful!).  Bune called me to let me know he would make all the arrangements with the hospital.  I didn't have to do any of the logistics myself.  In the end, I ended up only needing one more day, but it made a big difference for me.  I did have to pay money directly to the hospital for the extra day though.  It was about $300-$350 USD for the room, food, medication, and nurses for that extended stay.  Well worth the cost.  I travel with a credit card that has no foreign transaction fee, for unexpected expenses such as this.

I am staying at the One One Bangkok hotel.  I really like it here.  They have a 24 hr restaurant downstairs, and therefore 24 hr room service for food.  I have been ordering a lot of rice porridge from room service due to my limited digestion.  Also, free laundry service which is great (4 pieces of clothing per day).  It is in a great location just 5 min walking distance to PAI's clinic.  Before my surgery I walked there once just to confirm the distance, lol.  But despite the short distance, PAI has always arranged a driver to pick me up at the hotel so I don't even have to walk at all.  There is a pretty big grocery store next door (Villa Market) to buy all sorts of supplies, juices, drinks.  I have seen a lot of foreigners and westerners in that store.  And there are lots of small trendy cafes next door too.  Also lots of convenience stores and a bank practically next door for currency exchange.  There are so many stores and restaurants and businesses so closely packed here.  Such a convenient location for a hotel!

Dr Burin did not do a cosmetic revision on me.  I did not ask for it.  I feel pretty satisfied with the appearance of my external genitals.  I don't think it's Dr Chettawut's best work, but comparing to my friends who went to some other top tier surgeons, we tend to agree mine looks better than theirs anyway.

Can I ask why are you interested in sigmoid colon SRS?  Did your internal skin graft fail too?  I am starting to think that it is more common than I previously thought.

[AnonyMs]

It would be great if you could follow up with your recovery over the next few months and at one year. There's not much info about this kind of surgery.

[warlockmaker]

In Sigmoid Colon is the cut like a ceasrian birth cut which cuts the stomach muscle? Any muscle cut is really painful in recovery.

[SpiralCream]

Yes, the incision is at the same place as for a Caesarian section (c-section for birth).  If you do a google image search for c-section scars, you will get an idea of the location and appearance of the scar.  The length and appearance of my scar is exactly the same.  Location is same.  It is really painful down there (not the incision, but the muscles underneath).

[Linde]

Yes, the incision is at the same place as for a Caesarian section (c-section for birth).  If you do a google image search for c-section scars, you will get an idea of the location and appearance of the scar.  The length and appearance of my scar is exactly the same.  Location is same.  It is really painful down there (not the incision, but the muscles underneath).

Is there any reason not to do minimal invasive surgery (scope) for harvesting the colon section?  A scope incision would be about 1 cm or less long!  One might need tow such incisions for this kind of tissue harvesting!

[AnonyMs]

How long is the scar?

I wonder if people will mistake if for Caesarian section? Beats the usual scars for being stealth.

[Samanthaburgess]

Can I ask why are you interested in sigmoid colon SRS?  Did your internal skin graft fail too?  I am starting to think that it is more common than I previously thought.

I'm not really sure, after i had srs the inside of my vagina was very sore on the left side which made dilation really painful  and over the years it has gotten a bit better but even now after dilation and intercourse I am in a lot of discomfort for a couple of days afterwards, again inside on the left side, and there's always been a smear of blood left down one side of my dialator. I've always had a bit of funky discharge as well. When i left Thailand after srs I had lost about an inch of depth and over the years I've been fighting to keep depth and i've lost another 3 inches of depth over 15 years. I feel now its time to do something about it. What you went through sounds very similar, with me it just happened over a longer period of time.

Can you see the red of the colon graft at your vaginal entrance or did they manage to hide it?

Sam x

[SpiralCream]

Is there any reason not to do minimal invasive surgery (scope) for harvesting the colon section?  A scope incision would be about 1 cm or less long!  One might need tow such incisions for this kind of tissue harvesting!

Although laparoscopic sigmoid colon SRS is an option, Dr Burin explained to me that the results are different.  He showed me diagrams during my pre-consultation showing the difference in technique.  IMO, the biggest disadvantage for laparoscopic technique is that the vaginal depth is significantly less.  Average depth is only about 5.5 inches (you will find similar results when searching studies online).  Whereas with the open technique patients regularly get 7 inches or more of depth.  I suppose there is the downside of a larger scar, but it is actually quite easily hidden.  My scar is very low and easily hidden by any normal pair of panties, even hipster or bikini styles.  Probably not with a string thong though, lol.

I think I remember reading a post here at Susan's Place from someone who went to Dr Kaushik in India for sigmoid colon SRS.  And I think I remember the person asked Dr Kaushik if he could do the laparoscopic technique.  He said that he could, but that results would be better with the open technique.  Does anyone remember where that post is?  During my research I ran across it, but I can't remember where in this forum it was located and exactly what was written.

[SpiralCream]

How long is the scar?

I wonder if people will mistake if for Caesarian section? Beats the usual scars for being stealth.

I just measured it.  My scar is about 4.7 inches long.  That is well within the range of a c-section scar (4-6 inches).

[SpiralCream]

I'm not really sure, after i had srs the inside of my vagina was very sore on the left side which made dilation really painful  and over the years it has gotten a bit better but even now after dilation and intercourse I am in a lot of discomfort for a couple of days afterwards, again inside on the left side, and there's always been a smear of blood left down one side of my dialator. I've always had a bit of funky discharge as well. When i left Thailand after srs I had lost about an inch of depth and over the years I've been fighting to keep depth and i've lost another 3 inches of depth over 15 years. I feel now its time to do something about it. What you went through sounds very similar, with me it just happened over a longer period of time.

Can you see the red of the colon graft at your vaginal entrance or did they manage to hide it?

Sam x

Sorry to hear about your loss of depth and struggle with pain.    I also had pain inside my vagina because of the failed skin graft that had turned into granulation tissue.  Now I am 11 days post-op and already I have no more pain in that space inside. The damaged tissue was removed during my surgery and replaced with the sigmoid colon graft.  I am also surprised not to have any more bleeding, even while dilating.  Overall my discharge, even this early in recovery, is less than I had before my surgery with my granulation tissue.

When I asked him, Dr Burin told me that he connected the colon graft 1.2 inches past my vaginal introitus.  From there, it is possible to see the red of the colon tissue.  So yes, I can see it, but it's not that easy to see.  Dr Burin held it open with a speculum then handed me a mirror so I could see it.

[Samanthaburgess]

Thanks, but its something I've learned to live with. Glad to hear you have no pain inside, that must be a relief

How long do you have to dilate for now and how much depth did you end up with? Have your bowl movements gotten back to normal?

I sent an email to PAI this morning to enquire about the surgery, your post has been so helpful to me

[Linde]

Although laparoscopic sigmoid colon SRS is an option, Dr Burin explained to me that the results are different.  He showed me diagrams during my pre-consultation showing the difference in technique.  IMO, the biggest disadvantage for laparoscopic technique is that the vaginal depth is significantly less.  Average depth is only about 5.5 inches (you will find similar results when searching studies online).  Whereas with the open technique patients regularly get 7 inches or more of depth.  I suppose there is the downside of a larger scar, but it is actually quite easily hidden.  My scar is very low and easily hidden by any normal pair of panties, even hipster or bikini styles.  Probably not with a string thong though, lol.

I think I remember reading a post here at Susan's Place from someone who went to Dr Kaushik in India for sigmoid colon SRS.  And I think I remember the person asked Dr Kaushik if he could do the laparoscopic technique.  He said that he could, but that results would be better with the open technique.  Does anyone remember where that post is?  During my research I ran across it, but I can't remember where in this forum it was located and exactly what was written.

I hope they explain to you how to do proper scar massage?  With the right massage you can make the scar to be almost invisible, and it can look like a skin fold line.

[SpiralCream]

Thanks, but its something I've learned to live with. Glad to hear you have no pain inside, that must be a relief

How long do you have to dilate for now and how much depth did you end up with? Have your bowl movements gotten back to normal?

I sent an email to PAI this morning to enquire about the surgery, your post has been so helpful to me

I am glad I can help.  When I was in your situation I was frustrated with the lack of information online about this surgery.  There is also a lot of misinformation too.  For example people seem to have this misconception that the discharge smells like poo for a while because it was colon tissue.  Now that I've had this surgery, I can say that is completely untrue.  It has never smelled like poo, not even the first few days of recovery in the hospital.  The colon tissue is thoroughly cleaned before the surgery and so there is no poo smell.

My bowel movements are irregular though and will continue to be for the first month or two.  I finally had my first poop at 10 days post op.  It was mostly diarrhea (similar to my first poop after my first SRS).  I had to go several times the first day.  Digestion is still delicate and I have to restrict my diet for the time being.  No high fiber foods, no vegetables, and no fruits for a while.  Only soft foods, no processed meat like sausage, and no beef.

As for dilations, I only need to dilate twice a day for 15 min each session.  I was instructed to use the smallest dilator (28 mm diameter) for the first 1-2 months.  After that, I can gradually work my way up in dilator size.  The important thing is for me to dilate past the connection point - where the sigmoid colon was attached to my internal vaginal canal.  As I wrote before, that is at 1.2 inches past my vaginal introitus.  Once I get past that point, I don't need to go much deeper.  Dr Burin said I can go to just 4-5 inches for now.  But he warned me not to try for anything deeper than that until 2 months later, so that the end of the colon graft can heal.  I am sure it is deeper than 6 inches (since they used 8 inches of my sigmoid colon), but I'm not going to test it for now.  Once I get past the 1.2 inch connection point, it slides in very easily.  But it can be a bit difficult to get past that connection point.  I need to keep dilating that connection point while it is healing, so that it doesn't scar and shrink.  The colon tissue itself has no risk of shrinking though.  Dr Burin reassured me that I will never lose depth by not dilating to maximum depth.

PAI has a separate set of dilators for sigmoid colon patients.  It is an additional cost of 6000 Thai Bhat, so be prepared to bring some extra money for it.  The dilators are acrylic and have a curved tip, unlike the straight tip dilators that they give to patients who had penile inversion.  My dilator set has 4 dilators - 28 mm gray, 31 mm blue, 34 mm green, and 36 mm orange.

[AnonyMs]

PAI has a separate set of dilators for sigmoid colon patients.  It is an additional cost of 6000 Thai Bhat, so be prepared to bring some extra money for it.  The dilators are acrylic and have a curved tip, unlike the straight tip dilators that they give to patients who had penile inversion.  My dilator set has 4 dilators - 28 mm gray, 31 mm blue, 34 mm green, and 36 mm orange.

Sounds like the Soul Source dilators. Do you know why they give you different dilators?