What is J-pouch surgery?

J-pouch surgery is a procedure that is performed after a patient has had a proctocolectomy. This is an operation to remove the colon (large intestine) and rectum, the organs that store and eliminate solid wastes. The colon and rectum are removed in certain disease conditions including:

  • Chronic (long-term) ulcerative colitis inflammation of the mucosal lining of the rectum and colon (tiny ulcers and small abscesses in the colon and rectum that flare up and cause bloody stools and diarrhea).
  • Hereditary forms of colorectal cancer or multifocal colon and rectal cancer.
  • Familial adenomatous polyposis (an unusually large number of polyps in the colon).

If you have had these organs removed, you may have an ileal pouch-anal anastomosis (IPAA) procedure to provide a new way to store and pass intestinal contents per anus. In an IPAA, the ileum (the lowest part of the small intestine) is formed into a pouch to store solid wastes. This pouch is connected to the anal canal, allowing you to store and pass stool through the body’s usual route.

There are three types of ileal pouches: J-pouch, S-pouch and the W-pouch. The J-pouch is the type that is used most often because it requires the shortest length of intestine, is the easiest to construct, and provides the best function.

In order to have an ileal pouch procedure, your intestinal muscles, sphincter, nerves and anus must still be able to function normally. This will allow the person to maintain control of bowel movements once a pouch is constructed.

Your doctor will look at various factors to determine if you are a good candidate for J-pouch surgery. These may include:

  • Conditions other than ulcerative colitis, such as Crohn’s disease, indeterminate colitis, IBD-unclassified: The J-pouch is not always the preferred treatment for these conditions.
  • Obesity: Obese patients tend to have a longer surgery time, increased difficulty of constructing a J pouch, an increased risk of infection, a longer recovery time in the hospital and more complications after surgery. If you are significantly overweight, your doctor might recommend that you try to lose weight before the surgery.
  • Lack of anal sphincter function: The lack of muscle control is often found in older patients and in women who were injured during childbirth.
  • Pelvic radiation before pouch surgery: This condition may relate to higher rates of pouch failure and pouchitis. In addition, pelvic radiation after J-pouch surgery can also cause problems such as pouchitis, diarrhea and night-time voiding. Pouchitis is an irritation and inflammation of the pouch.

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