Introduction:
J-pouch surgery is a procedure done after the removal of the colon and rectum. This surgery helps in eliminating waste normally after the removal of the large intestine and rectum. This surgery is also known as ileoanal anastomosis. This procedure avoids the need for a permanent opening in the abdomen (stoma) for passing bowel movements.
Why Is J-Pouch Surgery Done?
J-pouch surgery is most often used to treat ulcerative colitis and familial adenomatous polyposis which is an inherited condition with high risk for colorectal cancer. This surgery is done when medications fail to treat ulcerative colitis. Ulcerative colitis tends to affect both colon and rectum. J-pouch surgery is sometimes used to treat colon and rectal cancer.
What Are the Contraindications for J-Pouch Surgery?
J-pouch surgery is not indicated in the following conditions:
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Crohn’s disease.
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Obesity: Creating a J-pouch is difficult in obese patients and the surgery and recovery may take longer time than usual. So the patients are advised to reduce weight before undergoing surgery.
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Lack of Anal Sphincter Function: Anal sphincter function is reduced in old age and women who were injured during childbirth.
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Pelvic Radiation: Pelvic radiation both before and after surgery can increase the risk of pouchitis.
What Are the Types of Pouch Surgery?
There are three types of ileal pouches: J pouch, S pouch and W pouch. J pouch is the most often used surgery because it requires the shortest length of the intestine, easier to construct and gives the best result in function. Intestinal muscles, nerves and sphincter should function normally because once the pouch is created, they should be capable of controlling bowel movements.
How to Prepare for J-Pouch Surgery?
Site selection for an ileostomy is done. Several factors affect the ileostomy site including natural skin folds, muscles in the abdomen, scars, navel, waistline, hipbone, and visibility of the site. Proper selection of the site helps in easier healing after surgery. Inform the doctor about the medications you are taking before the surgery. Stop taking medications like blood thinners including Aspirin, Warfarin, or Clopidogrel. Inform about the habits such as caffeine, tobacco, and alcohol use, since they can interfere with healing after the surgery. Avoid smoking and alcohol before the surgery. The patient is asked to drink only clear liquids like broth, clear juice, and water before the surgery. Eating and drinking should be stopped the night before the surgery. An enema or laxative is given to clear out the bowel for the surgery.
What Happens During the Procedure?
J-pouch surgery is done using two methods: open method and the laparoscopic method.
In an open method, a large incision is made in the abdomen. In the laparoscopic method, several small cuts are made, through which surgical instruments and a long, flexible tube with a camera (laparoscope) is inserted. Laparoscopic methods have faster recovery and less pain. J-pouch surgery is done in one, two or three stages. It depends on the health condition of the patient.
The procedure is done under general anesthesia. This will make the patient sleep and feel no pain. The surgeon removes the entire colon and rectum. And then creates a pouch like the shape of J. The J-pouch is also called the ileal pouch or pelvic pouch. It is created by using two loops of the small intestine measuring six inches. The pouch is connected from the small intestine to the top of the anus to allow normal elimination of stool. A temporary opening (stoma) is created in the abdominal wall for eliminating the waste by a procedure called ileostomy. This stoma helps in elimination of stool into a bag called an ostomy bag when the J-pouch is healing.
A three stage procedure is recommended for patients with poor health condition, on high doses of steroids or those who have to undergo surgery to repair bleeding or toxic megacolon.
What Happens After the Procedure?
The patient stays in the hospital for about a week after the surgery. The patient is given antibiotics and painkillers. By the second day, the patient is advised to drink clear liquids. Then slowly thicker fluids and soft solid foods are added once the bowel begins to function normally.
The doctor recommends drinking lots of fluids to prevent electrolyte loss and dehydration. For about six to eight weeks, avoid raw fruits and vegetables, nuts, and popcorn which could irritate the anal area. Protect the skin around the anus with skincare to prevent irritation. Eat a moderate amount of food and chew them thoroughly. Eat a low fiber diet and then gradually increase. Eat potassium rich foods to cope with diarrhea. Avoid lifting and strenuous exercises. After the J-pouch surgery, most people will have frequent bowel movements up to 12 times, which gradually decreases. Mucus may leak through the anus, which is temporary. Women may experience irregular menstruation following the surgery.
After about three months of healing the doctor does a second surgery to remove the ileostomy to aid in natural removal of the stool.
What Are the Risks of J-Pouch Surgery?
J-pouch surgery has few risks and complications. They include:
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Diarrhea.
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Dehydration.
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Abdominal bloating.
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Cramps in the abdomen.
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Increased bowel frequency.
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Pouch bleeding.
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Narrowing of the area between the pouch and anus.
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Infection of the pouch (pouchitis).
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Sexual dysfunction in both men and women.
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J-pouch surgery does not affect the women’s ability to get pregnant, but it may affect fertility.
Pouchitis is the most common complication of J-pouch surgery. About half of the patients who have undergone surgery will have pouchitis once in their lifetime. But pouchitis is usually treated with a 7 days to 14 days course of antibiotics.
Conclusion:
J-pouch surgery has a good success rate and improves the quality of life. J-pouch surgery is preferred over ileostomy. Most people recover fully and resume their physical activities after the surgery.
