J-Pouch surgery

Specialty of Colorectal surgery

What is J-pouch surgery?

J-pouch surgery, also known as ileal pouch anal anastomosis (IPAA), is a procedure that is used to restore functionality to a patient’s digestive system by removing the large intestine and creating an alternative path for waste to pass from the small intestine to the anus. The procedure is used to assist in treating conditions such as ulcerative colitis, a disease of the large intestine, familial adenomatous polyposis (FAP), and bowel cancer. Patients are under full anaesthesia during the surgery.

Surgeon looking at patient about to perfrom J-puch surgery

Why is J-pouch surgery done?

J-pouch surgery is necessary when the tissue of the colon (also referred to as the large intestine or bowel) is so damaged that normal bowel movements are no longer possible. Tissue damage can occur from cancer, serious injuries, infections and inflammatory diseases. J-pouch surgery can be required when medication has failed, for example when trying to treat ulcerative colitis or for patients who have permanent damage from cancer.

A patient may choose to have a J-pouch surgery instead of an ileostomy because an ileostomy involves an external pouch which needs changed, where as a J-pouch is internal and allows the patient to remove stool in a more “normal” way. During an ileostomy, the small intestine is redirected to a stoma, which is an opening in the abdomen, and bodily waste flows into the opening and then into an ostomy bag which is connected to the opening.

For patients with Crohn’s disease, a permanent J-pouch may be often advised against due to the possibility that the new pouch will also develop inflammation and then need to be removed.

What does J-pouch surgery involve?

This procedure may require more than one operation to complete. While it can be completed in one step, a surgeon may recommend it be completed in two or three steps.

In the first step, the colon (upper part of large intestine) and rectum (lower part of large intestine) are removed. The pouch is created by taking the end of the small intestine and folding it onto itself, replicating a ‘J’ shape. This new pouch will replicate the function of the rectum and connect to a very short rectal stump or directly to the anus by allowing stool to pass voluntarily by the patient once it has healed.

In the same procedure as the J-pouch surgery, the patient may receive a non-permanent ileostomy, usually a loop-ileostomy. This temporarily means that rather than connecting the small intestine to the anus, it will connect to an ostomy bag which is placed around an opening in the abdomen so that the patient can discard of bodily waste while the J-pouch heals

In the case of a loop ileostomy at the same time as the ileal pouch anal anastomosis (J-pouch surgery), six to twelve weeks later the patient will have another surgery after the J-pouch has healed. The small intestine will be attached to a rectal stump or the anus, resulting in no need for the ostomy bag which will be removed. The end result is that the digestive system can work similarly to its previous capability; waste will flow through the small intestine, gather in the j-pouch and then exit the body through the anus.

How do you prepare for a J-pouch?

A consultation with a colorectal surgeon will provide the patient with information to decide if the chance of success outweighs the risks.

Aftercare

Many patients have a high quality of life after the procedure.

Possible side effects are:

  • An increased need to pass stool, possibly up to 10 times or more per day. This should decrease in time.
  • Pouchitis, which is when the J-pouch becomes inflamed.
  • While not usual, sexual function may be impaired
  • While very rare, a patient may experience constipation

The small intestine will need time to adjust to taking over the role of the large intestine. The patient will need to maintain a diet low in spices and acidic foods and avoid foods that are very high in fibre. A specialist should provide specific dietary information as part of the aftercare. Once the small intestine has adjusted, the patient can resume a diet more similar to their diet pre-surgery.

During the months after the operation while the patient recovers, they will gradually be able to resume every-day activities and physical activities as recommend by the doctor.

Alternatives to this treatment

Rather than a temporary ileostomy, a permanent ostomy bag may be desired by the patient. This could be due to recommendations by the doctor, or because the patient does not want to risk the side-effects or possible complications of the J-pouch surgery.

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