Ileonala anastomosis surgery, which is commonly termed as a J-pouch surgery allows you to eliminate waste material normally after your entire large intestine is removed. The procedure involves constructing a J-pouch after your surgeon removes your colon and rectum.
This procedure avoids the need for a permanent opening in the abdomen i.e. stoma for passing any bowel movements.
J-Pouch surgery is generally used for treating chronic ulcerative colitis and inherited conditions, like familial adenomatous polyposis, which carries a high risk of colon and rectal cancer.
In some instances, the procedure might be done when medications for treating ulcerative colitis are not successful in controlling the condition. It might also be done if precancerous changes or colon cancer is detected. The surgery is also used for treating colon cancer and rectal cancer.
Before the procedure, you should talk with your doctor if you use alcohol, tobacco any other drugs, as these can affect your healing and recovery.
Your healthcare team will examine you before your surgery to mark the ileostomy site. Several factors can affect ileostomy site selection, which includes your natural skin folds, scars, navel, muscles in your abdomen, waistline, hip bone and visibility of the site when you are sitting. It is important to select the location properly so that you can care for the ileostomy after your surgery.
During the procedure
J-pouch surgery is generally performed using minimally invasive (laparoscopic) methods. Instead of opening your abdomen with a relatively large incision (open surgery), surgeons usually prefer to create more than one smaller abdominal incision through which surgical instruments can be inserted. Next, your surgeon will also be inserting a laparoscope, which is a long, narrow tube with a camera at the tip.
During the surgery, first, the surgeon will remove your entire colon and rectum, preserving the muscles, sphincter and opening the anus at the end of your rectum.
Then he/she will construct a pouch-shaped like the letter J from the end of the small intestine. It will be attached to the opening at the end of the rectum. Next, for the elimination of waste, a temporary opening will be constructed in the abdominal wall, which is known as an ileostomy.
After around three months of healing, another procedure will be performed by your surgeon for closing the ileostomy, which will allow you to pass stool normally.
After the procedure
You will need to spend a little time in the hospital recovering as well as learning how to care for your ileostomy. You will likely receive pain medication or antibiotics as well.
Your doctor may recommend you to drink lots of fluids, which can be water or electrolyte replacement drinks, for avoiding dehydration as well as the loss of electrolytes. For around six to eight weeks, you will have to avoid certain kinds of foods, which can include raw fruits and vegetables, nuts, popcorn or any such food high in roughage. These kinds of foods can cause irritation in the anal area. If your stool is watery, then it is recommended that you eat certain kinds of foods such as rice, bananas or peanut butter.
For around four to six weeks after the surgery, try to avoid lifting or any kind of strenuous activity.
For the majority of people, children and adults alike, they can see an improvement in their quality of life, after the surgery. However, people who are over 45 years of age might experience more incontinence and may need to go to the bathroom more frequently at night. On average, most of the people who undergo this procedure generally have around six bowel movements a day and one at night. It is estimated that around 90 percent of people who undergo this surgery, can be satisfied with the results.
Though this surgery can’t affect a woman’s ability to have a regular pregnancy and delivery, it might sometimes affect fertility.
Risks and complications
Though J-Pouch surgery is generally successful in treating your ulcerative colitis, sometimes there might be few complications that can require follow-up treatment. If you experience any of these conditions, inform your doctor immediately-
Pouchitis: Inflammation of the pouch can be considered the most common complication of j-pouch surgery and it is known to occur in around 50 percent of patients. It should occur within the first two years and is treatable with antibiotics. Diarrhea, fever, crampy abdominal pain, increased stool frequency, joint pain, and dehydration are the symptoms of this complication.
Small Bowel Obstruction: This is less common, but it can develop due to adhesions, which are fibrous bands that can occur between tissue and organs after your surgery. Around two-thirds of people who develop a small bowel obstruction should be able to be treated with bowel rest, such as not taking food for a few days. However, others might require surgery for removing the blockage. Symptoms of this complication include crampy abdominal pain, inability to pass stool, vomiting, and nausea.
There are few other possible conditions that might also develop post-surgery, which include pelvic abscesses and pouch fistulas.
Pouch failure, which generally occurs only in a tiny percentage of patients, requires surgery for removing the pouch and to create a permanent ileostomy.