- J-Pouch Surgery
- Understanding the J-pouch surgical procedure
- What You Should Know About J-Pouch Surgery
- What to Expect After J-Pouch Surgery
- Potential Surgery Complications
- Surgery for ulcerative colitis: What to know
- Ileal Pouch Surgery (J-Pouch)
- Ileal Pouch: A Highly Specialized Procedure
- Who Should Have Ileal Pouch Surgery?
- Benefits of the Ileal Pouch
- Before the Surgery
- J-Pouch Surgery Gives Patient Her Life Back
A proctocolectomy with ileal pouch-anal anastomosis, or j-pouch surgery, is the most common surgical procedure recommended for ulcerative colitis patients when medications fail to control their symptoms.
This surgery involves constructing an ileal pouch anal-anastomosis (IPAA) or j-pouch. The surgeon will remove your colon and rectum and use the end of your small intestine, known as the ileum, to form an internal pouch, which is commonly shaped like a J.
Understanding the J-pouch surgical procedure
Video Length 00:02:29
Understanding the J-pouch surgical procedure Ileal Pouch Anal Anastomosis (IPAA) , also known as the J-pouch procedure, is often performed on ulcerative colitis patients and can occur in one, two, or three stages. Watch this video to understand how the two-stage procedure is done, common side effects, and potential risks involved.
00:00 If you’re all sort of colitis inflammation and symptoms have not been
00:05 controlled by medications your doctor may have recommended a common type of
00:10 surgery called proctocolectomy with ileal pouch anal anastomosis or IPA a it
00:17 involves removing the colon and rectum to form what is often referred to as a J
00:23 pouch this surgery may occur in one two or three stages depending on your health
00:30 we will review the most common procedure involving two stages during the first
00:37 surgery the colon and rectum are removed and a pouch commonly in the form of a J
00:42 is created at the end of the small intestine and joined to the top of the
00:47 anal canal which enables control over bowel motions at the same time a
00:53 temporary opening known as a loop ileostomy is created the ileostomy will
01:00 allow waste to pass through the abdominal wall into an ostomy bag while
01:05 the newly formed pouch heals the second surgery occurs after 8 to 12 weeks once
01:12 the pouch is healthy at this time the ileostomy is closed and the two ends of
01:18 the bowel are reattached waste is now able to pass through the small intestine
01:24 collect in the pouch and out through the anus after the surgery is complete your
01:30 body will need time to adapt to the pouch some patients may experience an
01:35 increased number of bowel movements but this will typically decrease after some
01:40 time another side effect known as pouchitis involves inflammation of the pouch
01:46 most cases are temporary and respond well to antibiotic treatment in certain
01:53 instances sexual function may also be affected as nerve damage may lead to
01:58 male sexual dysfunction in females scar tissues may surround the ovaries and
02:04 tube which could lead to infertility you should talk with your surgeon about
02:08 these risks and ask when it is safe to resume sexual activity
02:13 your doctor and healthcare team will work with you to help you understand all
02:18 of the risks and benefits of the J pouch
Crohn’s & Colitis Foundation, Copyright 2017
What You Should Know About J-Pouch Surgery
This surgical procedure can be performed in up to three stages, but is usually done in two.
The first surgery removes your colon and rectum, and preserves your anus and anal sphincter muscles. The ileum is made into a j-shaped pouch and connected to the top of your anal canal.
A temporary ileostomy is typically created to give your newly formed pouch a chance to heal. A loop of your small intestine will be pulled through an opening in your abdomen, called a stoma, to allow waste to exit your body into an ostomy bag.
During this time, you will need to wear an ostomy bag at all times and it will need to be emptied several times a day.
You will have your second surgery eight to 12 weeks later, once the pouch has healed.
The second surgery will reverse the temporary ileostomy and reconnect your small intestine. Your internal pouch will then collect waste and allow stool to pass through your anus in a bowel movement.
Some surgeons choose to perform this surgery in just one stage, in which the pouch is created and joined to the anus without a temporary ileostomy. This is done less often than the two-stage procedure because of an increased risk of infection.
A three-stage procedure may be recommended for patients who are in poor physical health, on high doses of steroids, or if they are required to undergo emergency surgery to repair bleeding or toxic megacolon.
In a three-stage procedure, the first surgery removes the colon and creates an ileostomy. In the second surgery, the rectum is removed and the ileum is formed into a pouch and connected to the anus. The third surgery is performed eight to 12 weeks after the second surgery to reverse the ileostomy and re-attach the small intestine to the pouch.
What to Expect After J-Pouch Surgery
Your body will need time to adapt to the pouch after your surgery. We can help you learn what to expect after surgery and questions you may want to ask your healthcare providers.
Some patients experience an increased number of bowel movements, sometimes up to 12 times per day. This will typically decrease over time.
Some male patients may experience sexual dysfunction as a result of nerve damage.
Female patients may develop scar tissue that surrounds their ovaries and fallopian tubes, which may lead to infertility.
Both men and women should discuss sexual function with their surgeon and ask when it is safe to resume sexual activity.
Ask your healthcare providers what supplies you may need at home, especially if you will have a temporary ileostomy.
Your healthcare team will advise you on how to manage your temporary ostomy and how to keep it clean.
Potential Surgery Complications
While j-pouch surgery is often successful in treating your ulcerative colitis, there are some complications that require follow up treatment. Seek immediate medical attention if you believe you have one of these conditions.
Inflammation of the pouch is most common complication of j-pouch surgery and it occurs in up to 50 percent of patients, usually within the first two years. Pouchitis is treated with antibiotics.
Symptoms of pouchitis may include:
Crampy abdominal pain
Increased stool frequency
Small Bowel Obstruction
This is a less common complication of j-pouch surgery that may develop due to adhesions, which are fibrous bands that may occur between tissue and organs after the surgery. About two-thirds of people who develop a small bowel obstruction are able to be treated with bowel rest, such as not eating for few days, and intravenous fluids during a short hospital stay. Other people may require surgery to remove the blockage.
Symptoms may include:
Crampy abdominal pain
Inability to pass stool or gas
Other possible conditions could develop post-surgery that require additional treatment or surgery, including pelvic abscesses and pouch fistulas.
Pouch failure, which occurs only in a small percentage of patients, requires surgery to remove the pouch and create a permanent ileostomy.
Surgery for ulcerative colitis: What to know
A person may need ulcerative colitis surgery if other treatments, such as medication, do not control their symptoms.
A person may also need surgery if they have colon cancer or precancerous changes in the colon.
Having ulcerative colitis raises a person’s risk of developing colon cancer, especially if they have had ulcerative colitis for 8 years or more.
Sometimes, people with ulcerative colitis need emergency surgery if they have a perforation (hole) in the colon or bleeding that will not stop.
There are two types of ulcerative colitis surgery:
Proctocolectomy with ileostomy
Share on PinterestUlcerative colitis surgery may involve doctors creating a new opening for the intestine outside the body.
Proctocolectomy with ileostomy involves the following steps:
- Removing the large intestine (colon and rectum) and anus.
- Moving the end of the small intestine (the ileum) to a spot in the lower abdomen, usually on the right side.
- Making an opening in the lower abdomen known as a stoma.
- Bringing the end of the ileum through the stoma and attaching the intestine to the skin. This creates an opening from the small intestine to the outside of the body.
- Attaching a bag called an ostomy pouch to the opening, which allows waste from the small intestine to empty into the pouch. A person will empty the pouch into the toilet throughout the day.
The stool that comes out of the small intestine is not solid, and so it can flow into the pouch without the individual noticing.
The stoma does not have a muscle, and people cannot control when the pouch fills up. Ostomy bags available today are flat, discreet, and odor-free.
People wear an ostomy bag under their clothes, where it is not noticeable. Special garments are also available that conceal the ostomy bag for intimacy.
After a person has a proctocolectomy with ileostomy, they will need to learn to care for their stoma and the ostomy pouch. As well as regularly draining the pouch, they must learn to clean the stoma area to avoid infections.
Some pouches are washable and reusable, while others are disposable. The type of pouch will depend upon a person’s preference.
Proctocolectomy and ileoanal pouch-anal anastomosis (IPAA)
Share on PinterestIPAA surgery is a procedure that avoids the need for a permanent ostomy bag.
Proctocolectomy and ileoanal pouch-anal anastomosis (IPAA) is a newer procedure that allows a person to have bowel movements out of their natural anal opening. This procedure is sometimes called ileoanal pouch reservoir surgery or J-pouch surgery.
IPAA preserves the anus, rather than removing it. This procedure involves the following steps:
- Removing the colon and rectum, but keeping the anus intact.
- Using the small intestine to create an internal pouch that collects the body’s waste. This pouch is sometimes called a J-pouch or ileoanal reservoir.
- Connecting the internal pouch to the anus.
Stool gradually collects in the internal pouch and exits the body via the anus, making it more like a standard bowel movement.
If a person’s anal muscles are in good condition, they will be able to feel stool coming out and will be able to use the toilet for bowel movements, as usual.
Although a surgeon preserves the anus with this procedure, the bowel movements are often more frequent and may be very soft or watery because the colon is missing.
Fecal incontinence (having an accident) may occur in some people, but medications are available that can help control bowel movements. A person should have good functioning of the anal muscles to help reduce the risk of incontinence.
Sometimes, surgeons perform IPAA in stages. The first stage involves making the pouch and connecting it to the anus. Then, the surgeon will leave the pouch alone to heal for several weeks.
The surgeon creates a temporary stoma and ostomy bag for use until the second procedure takes place.
After 2–3 months, they will close the temporary stoma in the abdomen and re-route the waste to the internal pouch and out via the anus.
Ileal Pouch Surgery (J-Pouch)
Ileal pouch surgery is a highly specialized procedure in which a patient’s colon and rectum are completely removed. The rectum is then replaced by connecting a piece of the patient’s small intestine to the anus, forming a J-shaped “pouch” through which waste is eliminated.
Ileal Pouch: A Highly Specialized Procedure
Ileal pouch surgery requires a high level of skill and experience in colorectal or colon surgery. UVA has two board-certified colon and rectal surgeons highly trained to do this procedure.
Who Should Have Ileal Pouch Surgery?
Candidates for ileal pouch surgery include patients with:
- Ulcerative colitis that is not responding to medical therapies
- Familial adenomatous polyposis (FAP)
Benefits of the Ileal Pouch
Ileal pouch surgery eliminates the need for a permanent ostomy bag since the rectum is recreated using the patient’s own small intestine. This allows the patient’s intestinal continuity to be restored so that evacuation of stool remains through the anus.
In many cases, ileal pouch surgery can be performed using minimally invasive laparoscopic surgery, which uses smaller incisions than traditional surgery and can result in less pain and a quicker recovery.
Before the Surgery
Patients must complete a series of tests before being designated as a candidate for ileal pouch surgery. A doctor will perform an exam to rule out Crohn’s disease, and the patient will be required to have a colonoscopy.
Patients must go without food for 24 hours before the surgery. They will also need to complete a cleansing prep to empty the bowel completely.
Weeks after the surgery when the pouch is completely healed the surgeon will undo the ileostomy, which is a temporary opening in the abdomen where digestive waste can leave the body. The patient will then be able to pass bowel movements through the anus. The new pouch is held together using titanium staples, which remain in the patient’s body permanently.
Ileal pouch surgery is a very effective treatment for ulcerative colitis and FAP, with a success rate of 90%.
Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.
J-Pouch Surgery Gives Patient Her Life Back
Shannon Kederis from Kentucky is one of the nearly 2 million Americans diagnosed with inflammatory bowel disease (IBD), a group of disorders that causes chronic inflammation of the digestive tract.
The two most common forms of IBD are Crohn’s disease and ulcerative colitis. Both conditions cause inflammation and sores in the tissue lining the digestive tract, leading to abdominal pain and frequent diarrhea. But while Crohn’s can develop anywhere in the digestive tract and penetrates into the deep layers of the lining, ulcerative colitis usually affects only the surface layer of the tissue lining the colon/large intestine.
“My mom and a great aunt had ulcerative colitis, so when I started to have symptoms, I knew what was going on. I was put on medication which worked for about eight years with very few symptoms,” says Shannon, a busy high school teacher.
Also an avid runner, Shannon trained and completed her very first marathon. Shortly thereafter, her ulcerative colitis flared up.
Despite trying several different medications, her symptoms were not resolved. Shannon had surgery to remove her colon and rectum at a Kentucky hospital. During the procedure, her small intestine was used to form an internal pouch or reservoir – called a J-pouch – that would serve as a new receptacle for waste.
“I thought I’d be fine – I was in good physical shape, and knew what to expect,” says Shannon. But complications with a temporary ostomy and the J-pouch resulted in her being hospitalized for nearly two months. “I had enough of being treated for a problem that just kept happening. Then, my father-in-law suggested the Cleveland Clinic — why didn’t I think of that?”
“I think the Cleveland Clinic saved my life. Dr. Hull gave me back my quality of life, so I’m really thankful.”
Online research along with a recommendation from another physician led Shannon to Tracy Hull, MD, a colorectal surgeon at Cleveland Clinic’s Digestive Disease and Surgery Institute.
“From the very first appointment I felt comfortable and confident with Dr. Hull,” says Shannon.
“About half of my patients come from a five-state area, and the other half come from all over the world,” says Dr. Hull. “I remember telling Shannon that I was going to hand stitch the pouch, because I wanted to give her the best shot at making things work, and I didn’t want her to have to continue going through surgeries.”
Dr. Hull performed surgery to repair the J-pouch that had been causing the ongoing complications. Following the surgery, Shannon had a temporary ostomy that was reversed after four months because the repaired J-pouch works properly.
“I’ve had to make some adjustments, but I’m back to eating pretty much whatever I want, and having energy again,” say Shannon. “I think the Cleveland Clinic saved my life. Dr. Hull gave me back my quality of life, so I’m really thankful.”
Related Institutes: Digestive Disease & Surgery Institute =”patient-story__story>