Ileoanal anastomosis (J-pouch) surgery

Overview

Ileoanal anastomosis surgery removes the large intestine and makes a pouch inside the body that allows a person to get rid of stool in the usual way. The surgery (pronounced il-e-o-A-nul uh-nas-tuh-MOE-sis) also is called J-pouch surgery and ileal pouch-anal anastomosis (IPAA) surgery.

The surgery avoids the need for a long-term opening in the abdominal wall for passing stool.

Why it's done

Ileoanal anastomosis surgery is most often used to treat long-term ulcerative colitis that medicine can't control. It also treats conditions passed through families that carry a high risk of colon and rectal cancer. An example is familial adenomatous polyposis (FAP).

Sometimes the procedure is done if there are bowel changes that could lead to cancer. And it's sometimes used to treat colon cancer and rectal cancer.

Risks

Risks of J-pouch surgery include:

• Blockage of the small bowel.
• The body losing more fluid than it takes in, called dehydration.
• Diarrhea.
• Narrowing of the area between the pouch and the anus, called stricture.
• Pouch failure.
• Infection of the pouch, called 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 like those of ulcerative colitis. These include diarrhea, abdominal pain, joint pain, fever and dehydration.

Contact your healthcare professional if you have any of these symptoms. Most often, antibiotics can treat pouchitis. A few people need daily medicines to treat or prevent pouchitis.

Rarely, pouchitis doesn't respond to daily treatment. Then surgeons may need to remove the pouch and make an ileostomy. An ileostomy involves wearing a pouch outside the body to collect stool. Removal of the J-pouch occurs in only a small number 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 that remains after removing the large intestine. For people with ulcerative colitis, what's left of the rectum may become inflamed with colitis. This is called cuffitis. For most people, cuffitis can be treated with medicine.

What you can expect

Before the procedure

A healthcare professional sees you before your surgery to mark the ileostomy site for the short-term ileostomy. Several factors affect where the site is.

These factors include your natural skin folds, the muscles in your abdomen, any scars you have, where your bellybutton is, waistline and hipbone, and being able to see the site when you sit. Choosing the right place for the ileostomy makes it easier to care for the ileostomy after surgery.

Food and medicines

Before your surgery, talk with your healthcare professional about your use of caffeine, alcohol, tobacco or other drugs. Using any of these before or after surgery may affect how you heal and recover.

During the procedure

When they can, surgeons do J-pouch surgery with minimally invasive methods. These are called laparoscopic methods. With these methods, instead of making a large cut, a surgeon makes smaller cuts in the belly area. These cuts are called incisions.

The surgeon then guides surgical tools through the incisions. One of the tools is a long, narrow tube with a camera at its tip, called a laparoscope.

Some laparoscopic J-pouch surgery is done using robotic techniques.

J-pouch surgery is most often done in two surgeries. During the first surgery, the surgeon:

• Removes the colon and rectum. The ring-shaped muscle, called the anal sphincter, and the anus, stay at the end of the rectum.
• Makes a pouch shaped like the letter J from the end of the small intestine and attaches it to the anus.
• Makes a short-term opening in the abdominal wall, called a stoma, for getting rid of waste.

You heal for about 2 to 3 months. Then the surgeon does the second surgery to close the ileostomy. This lets you pass stool as usual.

After the procedure

You spend a brief time in the hospital to heal and learn how to care for your ileostomy. You need to wear an ostomy bag that collects your stool until you have the next surgery.

Your healthcare professional may tell you to drink a lot of fluids. Water or drinks that replace certain minerals in the body called electrolytes will help keep you from getting dehydrated.

You may get pain medicines or antibiotics after the surgery. Your healthcare professional also might suggest anti-diarrhea medicines or fiber supplements.

There's no special diet for people who have had J-pouch surgery. Some foods, such as beans and cabbage, might cause gas or diarrhea. Alcohol might do the same.

You might try to eat small amounts of foods you like to see how they affect you. If your stool is watery, eat foods that help thicken stool, such as applesauce, bananas or peanut butter.

For about 4 to 6 weeks after J-pouch surgery, don't lift anything or do activities that strain the body. After that, being active can help the healing process. Most often you can return to the activities you did before surgery.

Results

Most people who have J-pouch surgery report a good quality of life. Around 90% of people are happy with the results.

Within a year after J-pouch surgery, most people have fewer bowel movements than they did right after surgery. Most people have 5 to 6 bowel movements a day and one or two at night.

J-pouch surgery doesn't affect pregnancy or delivery. But it may affect being able to get pregnant. If you want to be able to get pregnant, talk with your healthcare professional about the best approach for your surgery. Nerve damage might cause some erection problems after the surgery.

J-pouch surgery is most often chosen over a long-term ileostomy, which involves passing stool into an ostomy bag worn outside the body. Discuss with your healthcare professional which surgery is better for you.