J pouch Surgery

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. 

What to expect after Pediatric ostomy Surgeries

When your child gets out of ostomy surgery, they will need you to support them.  How can you help though? Well, read on to learn how to help with their needs. With this, you will probably learn that once they get out of surgery, they’ll probably be sleepy, and they may also have a pain pump to help with the pain after surgery. 

This only allows for a certain amount of pain killer at a time so that it doesn’t cause dangers to the body, and you should check their vitals to ensure that they’re taken care of. When they’re done, they probably are going to want to learn a little bit about the stoma that was created, or what this means for them, and it’s important that you do educate them a little bit on this. 

After a little bit, the doctors along with the nurses may ask for the child to walk around to help “wake up” the intestines. Usually, anesthesia causes the gastrointestinal tract to kind of fall asleep and it can be a bit of a problem over time. If they don’t get woken up, ileus can happen, and it can be hard to really get the bowels to work again. 

When your child notices that there is stoma output, at first they may not get it, but the nurses and their assistants will help to empty out the pouch. They’ll feel the first couple of times, but usually, they encourage both you and the child themselves to be more independent on this. 

They usually will want to have the child empty I out into a container to measure so that they can check the stoma output. During all of this, the surgeons will also discuss the progress of recovery as well.  You also will have a nurse come on in to teach the child how they can change their ostomy pouch, and usually, they’ll help the child get set up with suppliers so that you can get them their ostomy supplies easily. 

Once the stoma starts to output a little bit, they’ll only be allowed to have a little bit of residue in their diet, or liquids as well, in order to help with reintroducing this. The nurses along with the surgeons will want to make sure that the child does eat and drink a little bit at this point so that blockages don’t happen. 

Once the pain is properly managed and they can empty out the pouch and also eat easily, and when the doctor feels it’s time for them to be sent home, they’ll do this. Usually, the child does need to see a doctor a bit after surgery, and an appointment may be set afterward for the child to be checked in upon, but with this, there are definitely a lot of benefits to be had with this, and a lo of course, of different methods and other aspects for you to consider.

If you’re not sure about whether or not you’ll be able to help your child, talk to the ostomy nurse or the surgeon to find out what it’ll take for you to be able to help your child with all of this and to help get them the most care that you can. A lot of people don’t’ realize that there is a lot that goes into this, and it can be a bit step in a different direction, so making sure that you as a parent know-how in the world to help their kid can not only make the experience better, it can help your child as well.