Definition and Overview

An ileoanal anastomosis surgery, or more commonly called a J-pouch surgery, is a surgical procedure that enables a patient to pass waste products from the body even after having his colon and rectum removed. In the past, a permanent opening (stoma) is made in the abdomen. However, with the introduction of J-pouch surgery, patients with gastrointestinal issues that involve the large intestine can still pass bowel in the normal manner.

Just like most surgical procedures, ileoanal anastomosis surgery is typically not the primary treatment option for patients with certain gastrointestinal conditions. In many cases, doctors advise patients to use more conservative and less invasive treatments first, such as medications, dietary changes, and lifestyle changes, to minimise risk and complications. The J-pouch surgery is only used as a backup treatment or the last resort if the patient’s condition fails to improve despite undergoing non-invasive treatments.

Who Should Undergo and Expected Results

A J-pouch surgery is used as part of the treatment for the following conditions:

  • Chronic ulcerative colitis – More than half of all ileoanal anastomosis surgeries are performed to treat ulcerative colitis.

  • Familial adenomatous polyposis – This is an inherited condition in which abnormal growths develop along the inner lining of the colon, and is the second most common reason behind J-pouch surgeries.

  • Certain types of colon and rectal cancer – In some cases, ileoanal anastomosis surgery is performed to treat colon and rectal cancer.
    When used in such situations, the surgery has a high success rating. It offers long-term benefits for around 8 out of every 10 people who undergo the procedure. Most patients experience a better overall quality of life following said treatment. They do, however, have to deal with permanent, long-term consequences, such as more frequent bowel movements, which can range from 4 to 9 times in a day.

Despite the said consequences, ileoanal anastomosis remains the preferred treatment method for most patients who have been dealing with said conditions for a long time, as it eliminates the need for an ostomy, the surgical procedure that creates a stoma or permanent abdominal opening.

How is the Procedure Performed?

An ileoanal anastomosis surgery is performed in two stages, with the first stage being the removal of the large intestine and the creation of the anastomosis. The first part of the procedure is called a colectomy, or the removal of the colon, and proctectomy, or the removal of the inner lining of the rectum. The procedures effectively get rid of the diseased or damaged gastrointestinal tissue in the colon and rectum that causes the problem. Complete removal also ensures against future recurrences.

Once the large intestine is removed, the surgeon will attach the ileum, which is the lower end of the small intestine, to the anal opening to create a passage for waste products to exit the body normally while completely bypassing the need for the large intestines. Also, since the procedure maintains the muscles that are located around the rectum, the normal process of eliminating bowel is preserved.

The procedure is also called a J-pouch surgery because prior to connecting the ileum to the anus, the surgeon staples certain parts of the ileum to make a J-shaped pouch that will hold the patient’s stool before it exits the body. This gives the patient some time to hold the waste products before having a bowel movement.

However, before this can be achieved, the anastomosis needs to be given some time to heal, which usually takes 2 to 3 months. During this time, the patient eliminates bodily wastes through a temporary stoma or an opening in the abdominal wall.

The ileostomy or stoma, however, is only a temporary situation. During the second stage of the procedure, the stoma is closed up and the ileum is attached to the anal canal, restoring normal bowel movement. This follow-up surgery is scheduled when the anastomosis has healed.

Following the second and final procedure, the patient will enter a recovery period that normally takes around 1 to 2 weeks.

Possible Risks and Complications

Like any other surgical procedure, an ileoanal anastomosis surgery comes with some risks, which can range from minor to severe. These include:

  • Pouchitis, or when the ileal pouch itself becomes inflamed
  • Small bowel obstruction, or when the small intestine becomes blocked
  • Pelvic or abdominal sepsis, or when an infection develops
  • Incontinence, or when the patient experiences stool leakage
  • Sexual problems
  • Infertility

Patients are also susceptible to the usual risks of undergoing surgery, namely:

  • Excessive bleeding
  • Infection
  • Allergic reactions to the anesthetics used during the procedure

Patients who had a temporary ileostomy placed may also experience stomal prolapse, or when the ileum protrudes through the stoma. This can have emotional and psychological effects on patients. Thus, during the waiting period of 2 to 3 months prior to the second stage of the procedure, patients are encouraged to seek enterostomal therapy or join a support group to help them cope with their temporary situation.

To increase the chances of a successful surgery, patients are strongly advised to follow the surgeon’s post-surgical instructions. They are taught how to care for the J-pouch and how to minimise some minor symptoms commonly experienced after the surgery, such as diarrhea and gas.

They are also sometimes advised to seek the help of a dietitian who can create a diet plan appropriate for people living with a J-pouch. Some lifestyle changes will also be necessary.

References:

  • Buchwald H. Laparoscopic Roux-en-Y gastric bypass. In: Buchwald H. Buchwald's Atlas of Metabolic and Bariatric Surgical Techniques and Procedures. Philadelphia, PA: Elsevier Saunders; 2012:chap 6.

  • Pontiroli AE, Morabito A. Long-term prevention of mortality in morbid obesity through bariatric surgery: A systematic review and meta-analysis of trials performed with gastric banding and gastric bypass. Ann Surg. 2011;253:484-7. PMID: 21245741 www.ncbi.nlm.nih.gov/pubmed/21245741.

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