J-Pouch Information

 
     

Ileal Pouch

What is Ileal Pouch Reconstruction? Ileal pouch reconstruction has allowed patients with conditions such as ulcerative colitis, familial polyposis and certain types of colon cancer to avoid living with a permanent ileostomy and external appliance after a colectomy. The procedure involves removing the colon, rectum and anal canal lining and using the end of the small bowel (ileum) to create a new rectum. Since the first procedures, surgeons have improved both the pouch and the technique, eliminating many complications. The information provided here will give you an overview of ileal pouch reconstruction and the prognosis after surgery. We hope it will answer many of your questions regarding the procedure.

Ileal Pouch Types The J-, S-, and W-reservoirs are the most common types of pouches used. The number of limbs and the amount of small bowel used to create them distinguishes the various types of pouches and reconstruction procedures. The J-reservoir is made from two side-by-side limbs stapled together to create a J-Loop. An S-reservoir has three limbs and a short n5/26/07 W-pouch has four limbs and looks like two J-loops placed side by side. Function, capacity and elasticity vary with design. Selection of the pouch design depends on a variety of factors, including age, patient size, and individual anatomy.

Ileal Pouch Reconstruction Procedure Ileal pouch reconstruction is one of the most extensive and complex gastrointestinal procedures used today. The first part involves removal of the colon and rectum. Next, the small bowel's blood supply and mesentery (membranous tissue attaching the ileum to the body wall) to determine whether the ileum will reach the anal canal. Most patients' small 5/26/07of techniques will be employed to make the ileum reach the anal canal. In 5/26/074/18/08. The anal canal lining is also removed. After construction of the pouch, the reservoir outlet is sutured to the anal canal, and a temporary ileostomy is placed to protect the extensive anastomoses and allow the newly created pouch to heal. It is usually positioned slightly below and to the right or left of the navel. Ileostomy takedown. After approximately two months, you will be ready for the ileostomy takedown. This is the easier and less painful of the three surgeries! The doctors will remove the ileostomy, allowing the pouch to begin functioning on its own. Following the ileostomy takedown, normal ileal pouch function and bowel movements will begin. You will also have a small scar where the ileostomy used to be.

Factors for Unsuitable Candidates Patients who are not good candidates for total abdominal colectomy and ileal pouch reconstruction include those who:

  • Have Crohn's disease
  • Are incontinent and have poor sphincter muscle tone
  • Have had previous sphincter injury
  • Have undergone partial removal of the small bowel

In addition, some patients who are obese or who have heart and/or lung disease may be candidates.

What should I expect? Stool frequency and continence are the two main factors that determine optimal pouch function. Patients who have four to five bowel movements a day with nearly perfect continence are considered to have the best functional results. However, the first days will be the roughest.
Stool Frequency. A variety of factors, including age, eating habits, type of reservoir reconstruction and quality of the anal sphincter muscles, can affect stool frequency. At the time of the ileostomy takedown, the ileal reservoir has a fairly small capacity. Therefore, it's not uncommon to have 10 or more bowel movements a day. As the ileal reservoir adapts and stretches to its normal capacity, stool frequency will decrease. Most patients experience a decline in stool frequency during the first six to 12 months after surgery. Younger patients usually have fewer bowel movements than older patients. Other factors that can affect frequency are the amount of fiber in your diet or use of products such as Metamucil®, Lomotil® or Imodium® that help decrease stool frequency. Adjusting your eating habits and using certain medications can improve continence.

Operative Risks/Complications The vast nature of total abdominal colectomy and ileal pouch reconstruction predisposes you to complications that, if treated early, can be minimized. Some patients experience problems, the most common of which include bowel obstruction (frequently treated non-surgically), infection, anastomotic or pouch healing problems, and steroid withdrawal symptoms. Blood loss or anemia, poor nutrition, your age and previous surgery can increase your chance of post-operative problems. Bleeding, infection, incontinence or inadequate reach between the pouch and the anal canal may cause the ileal reservoir to fail. Such occurrences are infrequent. If the reservoir fails, a permanent ileostomy may be required.

Pouchitis, a non-specific inflammation of the ileal reservoir, can be a long-term problem for some patients. This usually occurs during the first two years after pouch reconstruction. Most have symptoms, including steadily increasing stool frequency that may be accompanied by incontinence, bleeding, fever and/or a feeling of urgency. Most cases can be treated with a short course of antibiotics. Even in severe cases, pouchitis rarely requires pouch removal. If you have any or all of these symptoms, notify your surgeon, primary physician or gastroenterologist immediately.

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