What is a J-Pouch?

This Type Of Surgery Is Typically Only Done In People With Ulcerative Colitis

Ileoanal pouch anastomosis
A j-pouch is constructed from the last part of the small intestine (the terminal ileum) and connected to the anus. People with a j-pouch use the toilet like people who have their colons. Image © National Institute of Diabetes and Digestive and Kidney Diseases

A j-pouch is an internal pouch that's created from the last part of the small intestine (ileum) and attached to the anus or the remainder of the rectum. To create the j-pouch, the terminal ileum is sewn back onto itself to form the shape of the letter "J." The purpose of the j-pouch is to hold stool, much like a normal rectum would. This surgery is also sometimes called pelvic pouch surgery, internal pouch surgery, and is referred to by the more technical medical term of ileal pouch-anal anastomosis (IPAA).

Major surgery is frightening, especially when the outcome is not assured. However, most people who have j-pouch surgery go on to have good results, and are happy with the outcome. In fact, it's estimated that about 95% of people who have j-pouch surgery are satisfied with their results.

Why Is J-Pouch Surgery Done?

J-pouch surgery is most often done to treat ulcerative colitis, but may also be done for a condition called familial polyposis. In ulcerative colitis, the large intestine (the colon) may be removed if it becomes too inflamed or if it may start to show signs of cancer. After the colon is removed, it can't continue to cause many of the hallmark signs and symptoms of ulcerative colitis, but that does not mean that other complications can't continue to occur.

Why J-Pouch Surgery?

The advantage of j-pouch surgery is that it allows patients to eliminate stool through the anus, in a more "normal" fashion.

Typically, removing the colon means that an ileostomy would be needed. With an ileostomy, there is a need for an ostomy pouch that is worn on the side of the abdomen to collect waste. For some people with ulcerative colitis, not having an ileostomy is preferable, and may improve their quality of life.

How Is J-Pouch Surgery Done?

The IPAA procedure is often done in two surgeries, though it is also sometimes done with one surgery, or three surgeries. During the surgeries, the large intestine and part or all of the rectum is removed, and the j-pouch is created.

The time between surgeries depends on several factors, including the patient's overall condition before the surgery and the pace of recovery. For those that are very ill, the surgery may be done in three parts. In some specialty centers, the surgeries can be done through laparoscopic surgery, also called minimally invasive surgery (MIS). In laparoscopic surgery, only small incisions are used. If this procedure is not an option, open surgery is done, and patients may have a sizable scar on the abdomen.  

In the two- or three-part procedure, a loop ileostomy is created in order to let the intestine and the j-pouch heal between surgeries. While the ileostomy is in place, waste is collected in a bag that is worn on the side of the body.

During the final surgery, the loop ileostomy is closed. Stool then passes through the j-pouch, allowing the patient to eliminate through the anus.

In some cases, the ileum is sewn into a different shape, such as an "S" or a "W," although these are less common than the "J." The shape of the pouch created is decided on by the surgeon.

Complications And Other Considerations

Most people who have j-pouch surgery go on to enjoy an improved quality of life. Potential complications after the surgeries include intestinal blockages and a condition known as pouchitis. Pouchitis is an inflammation of the j-pouch that can cause fever, pain, bleeding, and an increased number of stools. In many cases, pouchitis is treated with a course of antibiotics, or alternating courses of different antibiotics, Unfortunately, in some cases, pouchitis can become chronic. Pouchitis happens much more frequently in patients who have had the surgery done to treat ulcerative colitis than those who have had the surgery done to treat familial polyposis.

A special consideration for women is the potential for difficulty in becoming pregnant (infertility) after having j-pouch surgery. There is some evidence that if the surgery is done laparoscopically, the risk of infertility can be lowered.

Source:

Beyer-Berjot L, Maggiori L, Birnbaum D, et al. "A total laparoscopic approach reduces the infertility rate after ileal pouch-anal anastomosis: a 2-center study." Ann Surg. 2013 Aug;258:275-282.

Fazio VW, Kiran RP, Remzi FH, et al. "Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients." Ann Surg. 2013 Apr;257:679-685.

Gorgun E, Remzi FH. "Complications of Ileoanal Pouches." Clin Colon Rectal Surg. 2004 Feb;17:43–55.

Gorgun E, Remzi FH, Goldberg JM, et al. "Fertility is reduced after restorative proctocolectomy with ileal pouch anal anastomosis: a study of 300 patients." Surgery. 2004 Oct;136:795-803.

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