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Ileoanal pouch surgery, also known as a restorative proctocolectomy with ileal pouch-anal anastomosis, is a surgical procedure that allows you to eliminate waste (i.e. have a poo) after you have had your colon and rectum removed. People also call it a J-pouch procedure, because it creates a pouch at the end of your small intestine, which is attached to your anus and allows you to pass stools in the normal manner. This pouch is often shaped like the letter J.
The operation to create the pouch is typically the second of two procedures, which collectively might also be referred to as ileoanal pouch surgery or as J-pouch surgery. The first procedure is a colectomy, and usually a proctocolectomy, which means that all of your colon and rectum (also known as your large intestine) are removed.
Most people will have a loop colostomy during this first surgery, which is a temporary procedure that diverts waste from you small intestine into a stoma bag. The ileoanal pouch surgery creates a pouch using a section of your small intestine and connects this directly to your anus. Often the procedure can be performed using minimally invasive (laparoscopic or keyhole) surgery, but sometimes we will use open surgery.
This course of treatment can be used for colorectal cancers as well as chronic disorders of the large intestine.
Our experienced consultant surgeons see patients who are considering a colectomy and ileoanal pouch as well as patients who may already have had colectomy and are considering this procedure as a follow-up surgery. To learn more, call our team of advisors, or book a consultation online with one of our specialists.
This type of surgery is used to allow you to go to the toilet normally after a colectomy procedure, which removes part or all of your colon. This treatment can be used for:
- Ulcerative colitis
- Familial adenomatous polyposis (FAP)
- Crohn's disease
- Colon or rectal cancer
- Other diseases that affect the colon or rectum
Most commonly, ileonal pouch surgery is used when you have colorectal cancer or are at very high risk of it, or when you have a digestive condition such as ulcerative colitis that is not responding to treatment. The primary goal of ileoanal pouch surgery is to improve your quality of life by removing diseased or damaged tissue and restoring normal bowel function.
If you are experiencing symptoms that suggest you may need ileoanal pouch surgery, your first consultation with Circle Health Group is an important step in finding a diagnosis and treatment plan that is tailored to your needs.
During this appointment, your consultant will begin by taking a detailed medical history and conducting a physical examination. Depending on your specific situation, you may also need diagnostic tests or scans to help with diagnosis.
At Circle Health Group, we pride ourselves on taking a comprehensive approach to care. This means that your consultant will take the time to fully understand your condition and symptoms, and develop a bespoke treatment plan that is tailored to your needs.
Your first consultation is an important opportunity to discuss any questions or concerns you may have about your condition, as well as the treatment options available to you. Don't hesitate to ask any questions you may have, as we want you to feel fully informed and comfortable with your treatment plan.
If ileoanal pouch surgery is deemed the best course of action, your consultant will explain the procedure and provide you with information on what to expect during and after the surgery. They will also take the time to discuss any potential risks or complications associated with the procedure.
Ileoanal pouch surgery is typically performed under general anaesthesia, which means you'll be asleep during the procedure. Your anaesthetist will work with your surgeon to determine the most appropriate type of anaesthetic based on your medical history and the surgery you are having.
Wherever possible, we will perform the operation laparoscopically, which means we use 'keyhole' surgery techniques. This can offer reduced pain and shorter recovery times that traditional 'open' surgery, though it won't always be possible.
During ileoanal pouch surgery, your consultant will remove your colon and rectum and create an internal pouch from a portion of your small intestine. This pouch will serve as a new reservoir for stool, allowing you to have bowel movements after the surgery. Once the pouch is created, it will be connected to your anus to allow you to pass stool in a more normal way.
If you have had a loop colectomy, this will now be 'closed' and you will no longer need to use your stoma.
How long it takes to perform ileoanal pouch surgery can vary depending on several factors, including the complexity of the case and your overall health. Generally, the surgery can take several hours to complete, with most procedures lasting between three to five hours.
Recovering from ileoanal pouch surgery
Recovery from ileoanal pouch surgery can take several weeks to several months, and you'll need to follow your consultant's advice carefully to ensure a successful recovery. You'll likely need to stay in the hospital for a few days after the surgery, and your surgeon will provide you with specific guidelines for resuming normal activities, including work and exercise.
It's normal to experience some discomfort and fatigue in the first few days after the surgery, but most patients find their symptoms improve significantly before long. Your surgeon will provide you with detailed instructions for managing any pain or discomfort you may experience during the recovery period.
If you have any questions or concerns about what to expect during ileoanal pouch surgery, don't hesitate to ask your surgeon. They can provide you with more detailed information based on your individual case and help you feel more comfortable and informed about the procedure.
As with any type of surgery, ileoanal pouch surgery carries some risks and potential complications. Risks specific to this procedure include:
- Infection: There is always a risk of infection with any surgery, but this risk is generally quite low
- Bleeding: While bleeding is not common during ileoanal pouch surgery, it can occur in some cases
- Bowel obstruction: A bowel obstruction can occur when scar tissue forms and blocks the bowel
- Small bowel prolapse: This is a rare complication, but it can occur when a portion of the small bowel protrudes into the pouch
- Leakage: A leak can occur at the point where the small bowel is connected to the pouch
- Loss of bowel control: This is a potential complication that can occur when the sphincter muscles that control bowel movements are damaged during surgery
Risks of any operation include:
- Adverse reactions to anaesthetic
- Blood clots
- Allergic reactions to medications or materials used during surgery
- Breathing difficulties
When you choose to go private with Circle Health Group, you can expect:
- Flexible appointment times and locations to fit your routine
- The freedom to choose which hospital and consultant suit your needs
- Personalised, consultant-led treatment plans tailored to your individual needs
- Comfortable and safe private facilities maintained by expert multidisciplinary teams
- Private ensuite rooms as standard and delicious healthy meals
- Affordable, fixed-price packages with aftercare included
- Flexible payment options to help you spread the cost of your care
If you would like to learn more about colorectal surgery, book your appointment online today or call a member of our team directly.
Content reviewed by Circle in-house team in March 2023. Next review due March 2026.
- Ileoanal anastomosis (J-pouch) surgery, Mayo Clinic
- J-Pouch Surgery, Crohn’s & Colitis Foundation
- Ileal Pouches, Cleveland Clinic
- Technical Aspects of Ileoanal Pouch Surgery in Patients with Ulcerative Colitis, NIH
- Ileal pouch anal anastomosis, Nuffield Health
- Special Concerns for People with J-Pouches, UCSF Health
- Total Proctocolectomy with J-pouch Reconstruction for Ulcerative Colitis, Penn Medicine
