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.