Campaigns and awareness Case studies Len: one of the first APPEAR patients Len Durrant had never spent a day in hospital when, at the age of 56, doctors discovered a benign tumour in his stomach. He’d gone to see his GP in London in 2003 because he was losing weight (more than 2st in four months), and felt tired all the time. The tumour (weighing 6.6kg) was removed in February 2004. And Len thought he was on the mend. But two months later, he started bleeding profusely from the bottom, and his wife dialled 999. He underwent surgery, in which 8cm of his bowel was removed, and he woke up to find he’d been fitted with a colostomy bag. “I was devastated,” he said. “Living with that bag was horrendous. I didn’t want to sit next to anyone. If there was any smell about, I’d think it must be me. My family would always assure me it wasn’t me but I never believed them. Some people get on with a colostomy bag, but I couldn’t. “For two years I kept asking doctors the same question: can’t you do anything to get rid of this? They kept telling me I was beyond repair. “My wife was watching me retreat into my shell. I’d had enough of everything. I got to the point where life wasn’t worth living. “I was too embarrassed to talk about it – only the close family knew, and I swore them to secrecy. “I couldn’t cope with the prospect of living with a permanent colostomy. I thought there must be someone who could fix it. I looked on the internet. I just kept asking. “My son said I should give up and get on with the colostomy bag, but I told him I’d keep fighting until they screwed the lid of my coffin down. I’d never give up. Len’s persistence paid off, and in October 2005, consultant Peter Lunnis at the Homerton Hospital sent him to the Royal London where Professor Norman Williams was leading groundbreaking research into bowel disorders, funded by Bowel & Cancer Research. Meeting Professor Williams proved to be a game-changer “Professor Williams examined me and within minutes he said ‘that’s do-able’,” said Len. “I couldn’t believe it. I’d been told so many times nothing could be done that I thought he was telling me what I wanted to hear to get rid of me.” But Professor Williams was serious. His pioneering APPEAR technique, funded by Bowel & Cancer Research, uses a crescenteric incision between the scrotum (or back wall of the vagina in women) and the anal canal to reach the very low rectum, allowing the surgeon to retain as much of the sphincter muscle as possible. Traditionally surgery to remove the very low rectum has required patients to live with a colostomy bag for the rest of their lives because, without a sphincter muscle, it was impossible for them to have control of their bowels. Len’s APPEAR operation took place in January 2006 at the Royal London in Whitechapel. It was one of the first of its kind. APPEAR was a long journey, but it gave Len back his sense of self When Len woke after surgery, his colostomy bag had been removed, and replaced with a temporary ileostomy bag. “My body hadn’t been used to processing food for four years. The colostomy bag had been full of solids. This ileostomy bag took liquids. It took months before it became manageable but I struggled on because it was going to get me back to normality.” At the end of 16 months, in May 2007, the ileostomy was reversed, and Len woke up after the operation – without a bag. I couldn’t believe it. They’d joined me back together again. There was no bag. I wanted to laugh and cry at the same time. The APPEAR operation turned out to be a life-saver in more ways than one – the anaesthetist discovered that Len had a heart problem. And a triple heart bypass came next. “Now I feel better than ever. That period of my life is over and gone. I can’t change the past, but I do consider myself very lucky – it was luck that I ended up in front of the only surgeon in Britain who said he could help me. "Without Bowel & Cancer Research, that might never have happened."