Ileoanal anastomosis (J-pouch) surgery
Ileoanal anastomosis (il-e-o-A-nul uh-nas-tuh-MOE-sis) surgery (commonly called J-pouch surgery) allows you to eliminate waste normally after removal of your entire large intestine (colon and rectum).
J-pouch surgery is also known as ileal pouch-anal anastomosis (IPAA) surgery. The procedure avoids the need for a permanent opening in the abdomen (stoma) for passing bowel movements.
Why it's done
Ileoanal anastomosis is most often used to treat chronic ulcerative colitis and inherited conditions, such as familial adenomatous polyposis (FAP), that carry a high risk of colon and rectal cancer.
In some instances, the procedure is done when medications used to treat ulcerative colitis fail to control the condition. It may also be done if precancerous changes or colon cancer are detected. Ileoanal anastomosis is also sometimes used to treat colon cancer and rectal cancer.
J-pouch surgery has a few risks and complications, including ileostomy blockage, dehydration, diarrhea, narrowing of the area between the pouch and the anus (stricture), pouch failure, and infection of the internal pouch (pouchitis).
Pouchitis is one of the most common complications of ileoanal anastomosis. The risk of pouchitis increases the longer the J pouch is in place.
Pouchitis can cause symptoms similar to those of ulcerative colitis, including diarrhea, abdominal and joint pain, fever, and dehydration. Contact your doctor if you experience any of these symptoms. In most cases, doctors can treat pouchitis with antibiotics. A small number of people require medications on a daily basis to treat or prevent pouchitis.
On rare occasions, pouchitis doesn't respond to daily treatment. Then surgeons may need to remove the pouch and construct an ileostomy. Removal of the pouch occurs in only a small percentage of people with a J pouch.
Often as part of the surgery, the pouch is sewn to a small section of rectum called the cuff. For patients with ulcerative colitis, this remaining rectum may become inflamed with colitis, which is called cuffitis. For most people, cuffitis is usually treated successfully with medication.
What you can expect
Before the procedure
A nurse will see you before your surgery to mark the ileostomy site. Several factors affect ileostomy site selection, including your natural skin folds, muscles in your abdomen, scars, navel, waistline, hip bone and visibility of the site when you are sitting. Selecting the proper location makes it easier to care for the ileostomy after surgery.
Food and medications
Before your surgery, talk with your doctor about your use of caffeine, alcohol, tobacco or other drugs. Using any of these products before or after surgery may affect your healing and recovery.
During the procedure
When possible, surgeons perform J-pouch surgery using minimally invasive (laparoscopic) methods. Instead of opening the abdomen with a relatively large incision (open surgery), they typically make more than one smaller abdominal incision through which surgical instruments and a long, narrow tube with a camera at its tip (laparoscope) can be inserted.
During J-pouch surgery, the surgeon will:
- Remove the entire colon and rectum, preserving the muscles (sphincter) and opening (anus) at the end of the rectum
- Construct a pouch shaped like the letter J from the end of the small intestine and attach it to the anus (opening at the end of the rectum)
- Construct a temporary opening in the abdominal wall (ileostomy) for eliminating waste
After about three months of healing, the surgeon does a second procedure to close the ileostomy, allowing you to pass stool normally.
After the procedure
You'll spend a brief time in the hospital recovering and learning how to care for your temporary ileostomy. You may be given pain medication or antibiotics.
Your doctor is likely to recommend drinking lots of fluids, such as water or electrolyte replacement drinks, to avoid dehydration and loss of electrolytes. For about six to eight weeks, you should avoid certain foods, such as those high in roughage, including raw fruits and vegetables, seeds, nuts and popcorn. These foods can irritate the anal area. If your stool is watery, it may be helpful to eat certain foods, such as applesauce, bananas, rice or peanut butter.
For about four to six weeks after J-pouch surgery, avoid lifting and strenuous activities. After that, most any activity you choose will speed the healing process. The level and type of exercise you choose may depend on the exercises you were comfortable with before surgery.
For most people — children and adults alike — quality of life generally improves significantly after J-pouch surgery. However, people older than 45 years of age tend to experience more incontinence and have to go to the bathroom more frequently at night. On average, most people have about six bowel movements a day and one at night after J-pouch surgery. Most report a good quality of life, and around 90 percent of people are satisfied with the results.
J-pouch surgery doesn't affect a woman's ability to have a normal pregnancy and delivery, but it may affect fertility. If achieving pregnancy is a concern now or in the future, talk with your doctor about the best approach for your surgery.
J pouch surgery is generally preferred over an ileostomy. Discuss with your doctor which operation is best for you.