J-pouch surgery is a common procedure in cases where UC does not respond to medication. J-pouch surgery is also known as a proctocolectomy with ileal pouch-anal anastomosis (IPAA).
Ulcerative colitis (UC) is an inflammatory bowel disease that causes inflammation in the lining of the rectum and colon.
Many people with UC never need surgery. However, up to one-third of people living with the condition for 30 years may require surgery.
This article explains how J-pouch surgery works, what to expect after the procedure, and the benefits and risks.
A surgeon creates a J-pouch after they remove the large intestine, which consists of the colon and the rectum. After the surgeon removes the colon and rectum, they will use the small intestine to form a J-shaped pouch to collect stool. They will then connect this pouch to the anus, which is the opening of the rectum.
This procedure leaves the sphincter muscles that surround the rectum in place. These muscles contract and relax to control the release of stool.
The procedure also leaves the anus in place. As the surgery preserves the sphincter and the anus, a person who undergoes this procedure can have continued continence without the long-term need for a stoma and ostomy bag.
“The J-pouch has really become the preferred standard of care for a person with colitis,” Dr. Steven D. Wexner, Director of the Digestive Disease Institute at Cleveland Clinic Florida and Chairman of the Department of Colorectal Surgery, told Medical News Today.
Depending on a person’s overall health, the surgery may involve two or three procedures.
In the initial procedure, a surgeon will remove the colon and rectum but leave the muscles that surround the rectum and the anus. They will then construct the J-shaped pouch from the end of the small intestine before attaching the pouch to the anus.
The first procedure is known as an ileostomy. During this surgery, a surgeon will create a temporary opening in the wall of the abdomen and attach the end of the small intestine to this opening. This allows stool to pass through into an attached ostomy bag while the small intestine and sphincter heal.
After 8–12 weeks, a person will undergo the second surgical procedure, in which a surgeon will reverse the ileostomy by reconnecting the small intestine. At this point, the person will be able to have a normal bowel movement.
If the surgeon needs to perform the surgery over three separate procedures, they will:
- remove the colon and make the ileostomy
- remove the rectum and create the pouch from the end of the small intestine
- reconnect the intestine and reverse the ileostomy
People who may require three surgeries rather than two include those:
- on high dosages of steroids
- in poor health
- who need emergency surgery to repair bleeding or fix a toxic megacolon
After the first surgery, a person will stay in the hospital for a short period to recover and learn to care for their temporary ileostomy.
Once the second or third procedure is complete, a person will generally have another brief hospital stay before the healthcare team discharges them to finish their recovery at home.
During the recovery period, a person who has had J-pouch surgery may notice the following:
- fatigue, which will lessen over time as the body heals
- an increased number of bowel movements, which should decrease as the stool thickens
- increased need to pass stools at night
- diarrhea
- stool leakage and mild incontinence, which should decrease over time
- dehydration associated with diarrhea
- streaks of blood in the stool
- sexual changes
Certain risks accompany any major surgery. According to the Crohn’s & Colitis Foundation, risks specific to J-pouch surgery include:
- pouchitis
- small bowel obstruction
- pelvic abscesses and fistulas
- pouch failure
The American College of Gastroenterology also points out that it might be more difficult for a person to get pregnant naturally following the procedure.
Of these complications, pouchitis is the most common. Doctors can treat it with a course of antibiotics.
“I tell people that they will likely develop pouchitis at some point in their life following the procedure,” said Dr. Wexner. “However, most of the people I talk to would rather have a bout of pouchitis over a colitis flare.”
Most of the other complications are fairly rare and particularly unlikely if a surgeon with extensive experience performs the procedures.
“The outcome of the surgery depends on the surgeon. It’s very technically demanding and requires a lot of nuances,” Dr. Wexner added. “The patient should ask around for recommendations and seek someone who does a lot of these procedures.”
“The impact on the quality of life is profound,” Dr. Wexner said. “Most people say they wish they had done this sooner. It’s not just the bowels per se, but it is the colitis as well.”
J-pouch surgery allows a person to feel better without the long-term need for an ostomy bag. The ability to pass stool normally instead of through a stoma may also be of significant psychological benefit.
In addition, J-pouch surgery often reduces the number of medications that a person needs to take. After the surgery, many people with UC will no longer have the same level of pain, urgency, and diarrhea associated with the condition.
J-pouch surgery works by removing the large intestine and creating a J-shaped pouch out of the end of the small intestine to serve as the colon. The procedure relieves UC symptoms and allows a person to pass stool without the prolonged use of an ostomy bag.
“People with UC shouldn’t be scared of getting better. Surgery isn’t a failure,” Dr. Wexner told MNT. “It’s allowing a person to get rid of their symptoms.”