J-Pouch Surgery
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.
What You Should Know About J-Pouch Surgery
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This surgical procedure can be performed in up to three stages, but is usually done in two.
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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.
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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.
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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.
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You will have your second surgery eight to 12 weeks later, once the pouch has healed.
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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.
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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.
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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.
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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.
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Some patients may experience an increased number of bowel movements, sometimes up to 12 times per day. This will typically decrease over time.
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Some male patients may experience sexual dysfunction as a result of nerve damage.
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Some female patients may develop scar tissue that surrounds their ovaries and fallopian tubes, which may lead to infertility.
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Both men and women should discuss sexual function with their surgeon and ask when it is safe to resume sexual activity.
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Ask your healthcare providers what supplies you may need at home, especially if you will have a temporary ileostomy.
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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.
Pouchitis
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:
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Diarrhea
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Crampy abdominal pain
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Increased stool frequency
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Fever
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Dehydration
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Joint pain
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:
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Crampy abdominal pain
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Nausea
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Vomiting
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Inability to pass stool or gas
Other Complications
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.
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