Usually, a j pouch is done when you’re getting a proctocolectomy that includes the ileal pouch and anal anastomosis. This is usually done in patients that have ulcerative colitis, when the medications don’t control the symptoms. Usually, the surgery does entail making an IPAA pouch, and from there, the colon and rectum are removed, and then, they use the ileum to create a pouch internally that’s like a J shape.
The procedure
This procedure is done in up to three types of surgeries, but usually they try to do it within two, sometimes one. The first step is they remove the rectum and colon, keeping the anal sphincter and anus there. The ileum is then created into a J shape and then connected to the top part of the anal area. They may at this point create a temporary ileostomy to give the pouch a chance to heal before they fully connect all of this. The ileostomy does involve pulling the small intestine outwards, creating a stoma to help eliminate waste.
During this, you will have to wear ostomy bags, and it may need to be emptied frequently. You also will need to recover from the surgery over time. So about 8-12 weeks later, you then get another surgery, and this is done once the pouch has healed up from the first surgery. The process for the second surgery is reversing that temporary ileostomy, connecting the small intestine to the J pouch in order to create a normal gastrointestinal tract. Some surgeons may do this in one stage, but usually this isn’t done as much, since there is higher risk for infections.
Three stages are done usually for those who don’t’ have the best health, who are on a lot of steroids, or who need to get emergency surgery to help with bleeding in the colon, or what’s called a toxic megacolon. The three stage procedure begins with the ileostomy, and then the second is the removal of the rectum and the formation of the J pouch. Your third surgery is to reverse your ileostomy, attach the small intestine that’s there to the pouch itself.
What to expect
After you get this surgery, you probably are going to feel very sore and tired over time. Some patients also notice that they can have almost 12 bowel movements a day, which does decrease as time goes on. Some male patients may deal with sexual dysfunction due to nerve damage, which is something they need to talk to the doctor about.
In female patients, there might be scar tissue around your ovaries along with the fallopian tubes, which can lead to fertility issues. Both genders should talk about sexual functions and how it may impact them, along with when they can resume doing sexual activities with their partner. You also should make sure that you talk to your doctor about the supplies to have at home f you have a temporary ileostomy. They can direct you on the best types of items to use, and of course, how to apply them whenever you need them, making this easier for you as well.
Complications
There are a few complications that can happen. Probably the most common though is the pouchitis, which happens in up to half of patients, which includes diarrhea, pain in the abdomen, stool frequency increased, fevers, joint pain, and dehydration. You also may want to be mindful of small bowel obstruction too, which is less commonplace, and usually can sometimes cause issues with the adhesions, which are the bands between the tissues. Usually, it has to be treated with surgery or IV fluids.
