What Is an Ileoanal Anastomosis (J-Pouch) Surgery?

An ileal pouch-anal anastomosis (J-pouch) is a surgical procedure to restore the stomach and bowel (gastrointestinal) continuity after the surgical removal of the large bowel (the colon and rectum). 

An ileal pouch-anal anastomosis (J-pouch) surgery treats the stomach and bowel.

Many conditions, including inflammatory diseases, cancer or infection, may necessitate the complete surgical removal of the colon and rectum.

• The procedure involves the creation of a pouch of the small bowel to recreate the removed rectum (the part of the large bowel above the anus). 
• Two or more loops of bowel are surgically stitched (sutured) or stapled together to form a reservoir for stool. 
• This reservoir is then attached to the anus to eliminate waste normally after the removal of the entire large bowel. 
• The Ileoanal anastomosis (J-pouch) is often protected by temporarily diverting the path of stool through a temporary opening on the abdomen (ileostomy). 
• After recovery, this ileostomy is reversed during a separate procedure.

The J-pouch surgery is performed after the large bowel (the colon and rectum) has been completely removed. It is performed under the following conditions:

• Inflammatory bowel disease (ulcerative colitis or, rarely, Crohn’s disease)
• Certain cancers of the large bowel
• Disorders of excessive colonic polyps (abnormal tissue outgrowths in the large bowel)
• Toxic megacolon (a potentially life-threatening complication of inflammatory bowel disease or infectious colitis characterized by abnormal dilatation of the colon)
• The surgery should, however, be avoided when the small bowel is involved in the disease process, as seen in many cases of Crohn’s disease.

The following will help you understand what to expect during an ileal pouch-anal anastomosis (J-pouch) surgery.

Before the surgery

Your doctor may:

• Order some blood tests and imaging studies (such as ultrasound, computed tomography [CT] and magnetic resonance imaging [MRI])
• Ask you about any chronic health conditions
• Ask you about any medications you are on
• Ask about any allergies you may have
• Explain the surgical procedure in detail, including possible complications, and address your doubts and concerns related to the surgery
• Obtain your written consent
• Ask your permission to perform a bowel preparation to clear the colon of waste, thereby reducing the bacterial load and chances of complications. This is usually done the day before the surgery with 4 L of a polyethylene glycol electrolyte solution or 300 mL of a magnesium citrate solution.
•  Ask you to maintain a clear liquid diet the day before the surgery and to not eat or drink anything for 8-12 hours before the surgery

During the surgery

• You will be asked to wear a hospital gown.
• You will lie on your back in the lithotomy position (legs in stirrups or “frog-leg" position).
• The anesthesiologist will administer general endotracheal anesthesia (general anesthesia with the airway protected using a breathing tube).
• This surgery is usually performed in two stages.
• The first surgery removes the colon and rectum. 
• The second part involves the ileum (small bowel) being made into a J-shaped pouch and connected to the top of your anal canal.
• A temporary ileostomy is performed to give your newly formed pouch a chance to heal. A loop of your small bowel will be pulled through an opening in your abdomen, called a stoma, to allow waste to exit your body into a stoma bag.
• A second surgery may be performed 8-12 weeks later.
• The second surgery reverses the ileostomy and reconnects your small bowel to the pouch.
• The internal pouch collects waste and allows stool to pass through your anus in a bowel movement.

After the surgery

• You may have an increased number of bowel movements, sometimes up to 12 times per day. This generally decreases over time.
• You should discuss sexual functions with your surgeon and ask when it is safe to resume sexual activity.
• You may ask your nurse or doctor what supplies you may need at home, especially if you will have a temporary ileostomy.
• Your nurse or doctor will teach you how to manage the ileostomy and how to keep it clean.