pouch

In the process of getting a J-pouch, all of the colon and virtually all of the rectum are removed. The anal muscles are preserved plus a couple centimetres of the lining of the rectum. A reservoir is constructed out of small bowel and is then connected to the anus.

There is a disadvantage in having this done, as it is a very complicated procedure. There are increased risks such as Pouchitis (inflammation of the pouch) and there is also still a risk of cancer, since the lining of the rectum is still there.

The procedure can be done in 1,2 or 3 stages depending on your health and the decision that you and your doctor make together.

Two stage operation:
First stage:
The colon and rectum are removed, leaving the anal mucosa or lining. The doctor will then free up the small bowel and join loops of bowel together to create the Pouch. To do this, First, two loops of small bowel are freed and placed side by side in an A shape Pattern. Then, the walls of the loops of bowel are opened. And then third, the open walls are stitched together to form a large pouch. The newly created pouch is then pulled through the remaining ano-rectal muscles and joined to the anus using a special stapler. Now to make the loop ileostomy that you will have while you heal, a seperate loop of small bowel is pulled through an opening that your surgeon will make in your abdomen. An opening is made in the bowel so that the stool will exit through there, not allowing the pouch to be used initially.

Second Stage:
A second operation is required about 3 months after the first one. In this one, the opening to the loop ileostomy is closed and the bowel is sewn or joined back together and now the pouch will be used and you will be able to go to the bathroom normally again.

Three Stage Operation:
First stage:
The first operation is the ileostomy operation, The colon is removed leaving the rectum in place. This is known as a subtotal colectomy. The end of the small bowel or ileum is is brought through the surface of the abdomen and now you have your brand new stoma.

Second Stage:
About 3-6 months later, the rectum is removed leaving the anal sphincters intact. The remaining mucosa is preserved. The doctor will free up the small bowel and join 2 loops together to form the j-pouch. Then the newly created pouch is pulled down through the remaining ano-rectal muscles and joined to the anus using a special stapling device. A seperate opening is now made in the abdomen and a seperate loop of bowel is brought out. an opening in this loop is made, allowing stool to leave the bowel there and not continue on to the newly created pouch.

Third Stage:
Approximately 3 months later, the openings to the loop ileostomy are closed and the bowel is sewn back together. The stool will then pass through the small bowel and into the internal pouch.

One Stage Operation:
In this operation, the 2 stage operation is done in one stage only without creating an ileostomy, therefor, you will not need stage 2 to close the stoma.