Ileoanal anastomosis surgery removes the large intestine, also called the colon, and the rectum. The surgeon then makes a pouch inside the body using the end of the small intestine. This part of the small intestine is called the ileum. The surgery (pronounced il-e-o-A-nul uh-nas-tuh-MOE-sis) also is called J-pouch surgery and ileal pouch-anal anastomosis (IPAA) surgery.

Ileal anastomosis surgery is most often done in stages. During the stages, the surgeon takes out the diseased colon and rectum, forms a pouch from the last part of your small intestine, the ileum, and connects the pouch to your anus. The connection is called an anastomosis. "Anastomosis" means to join or connect two parts during surgery.

Inside the body, the pouch stores stool. The stool then leaves the body through the anus. With this surgery, you may not need a lifelong opening in the belly wall for passing stool into a bag outside the body.

Types

J-pouch surgery may be done in one, two or three surgeries, called stages. The number of stages depends on your health, your diagnosis, whether surgery is urgent and your surgeon's approach.

Some stages involve bringing the ileum through an opening in the belly, called an ileostomy. An ileostomy allows stool to leave the body through the opening and empty into a bag. The opening is called a stoma.

• One stage: In a one-stage operation, the surgeon removes the colon and rectum. The surgeon then makes the J-pouch without an ileostomy.

• Two stages: In the first stage, the surgeon removes the colon and rectum and makes the J-pouch. The surgeon then makes a temporary ileostomy. In the second stage, the surgeon closes the ileostomy after the J-pouch heals.

  A modified two-stage approach starts with removing the colon and making an ileostomy. A later surgery removes the rectum and makes the J-pouch.

• Three stages: A three-stage operation starts with removing the colon and making an ileostomy. Next, the surgeon removes the rectum and makes the J-pouch and a temporary ileostomy. The final surgery closes the ileostomy.

Ileoanal anastomosis surgery most often treats long-term ulcerative colitis that medicine can't manage. It also treats conditions passed through families that carry a high risk of colon and rectal cancer. An example is familial adenomatous polyposis (FAP).

Sometimes the procedure is done if there are bowel changes that could lead to cancer. And it's sometimes used to treat colon cancer and rectal cancer.

J-pouch surgery may be done instead of a long-term ileostomy, which involves passing stool into an ostomy bag worn outside the body. Discuss with your care team which surgery may fit your health needs and what you prefer.

Risks of J-pouch surgery include:

• Swelling and irritation of the pouch. This inflammation of the pouch is called pouchitis.
• Blockage of the small bowel.
• The body losing more fluid than it takes in, called dehydration.
• Narrowing of the area between the pouch and the anus, called stricture.
• Pouch failure.

Pouchitis is the most common complication of J-pouch surgery. Pouchitis can cause symptoms such as loose stool, belly pain, joint pain, fever and dehydration.

Contact your healthcare professional if you have any symptoms of pouchitis. Most often, antibiotics can treat pouchitis. Some people need to stay on antibiotics to keep pouchitis from coming back.

Rarely, antibiotic treatment doesn't work. This can lead to pouch failure. Then surgeons may need to remove the pouch and make an ileostomy. An ileostomy involves wearing a bag outside the body to collect stool. Removal of the J-pouch happens in only a small number of people with a J-pouch.

Often as part of J-pouch surgery, the pouch is sewn to a small section of rectum called the cuff. The cuff remains after the large intestine is removed. For people with ulcerative colitis, what's left of the rectum may become inflamed with colitis. This is called cuffitis. For most people, cuffitis can be treated with medicine.

Your care team watches for complications and treats them as needed.

How you prepare

Your care team tells you how to prepare. This may include when to stop eating and drinking, how to take your usual medicines, and what to bring to the hospital.

Talk with your healthcare professional about your use of caffeine, alcohol, tobacco or other drugs. Using any of these before or after surgery may affect how you heal and recover.

If pregnancy is part of your plan, talk with your care team before surgery. J-pouch surgery may not affect delivery. But scar tissue from the surgery may affect being able to get pregnant. Nerve damage from surgery also may affect erections.

Before the procedure

Before your surgery, a healthcare professional marks the site on your belly where the short-term ileostomy will be. Several factors affect where the site is. The site should make the ileostomy easier to care for after surgery.

During the procedure

J-pouch surgery is a major operation. Your care team takes you to an operating room and gives you medicine that puts you in a sleeplike state, called general anesthesia. You feel no pain during the procedure.

When they can, surgeons do J-pouch surgery with minimally invasive methods. These are called laparoscopic methods. Often, surgeons use robotic techniques. These methods most often involve small cuts in the belly area rather than a large cut. The cuts are called incisions.

The surgeon then guides surgical tools through the incisions. One of the tools is a long, narrow tube with a camera at its tip, called a laparoscope.

J-pouch surgery may be done in one, two or three stages. This is what happens during a three-stage procedure:

• Stage 1. The surgeon removes the colon and leaves the rectum in place. The surgeon then makes a short-term opening in the belly wall, called a stoma. The surgeon makes a loop of the end of the small intestine, called the ileum, and brings it through the stoma. This lets stool leave the body into an ostomy bag.
• Stage 2. After you heal for about 3 to 6 months, the surgeon does the second surgery to remove the rectum. The surgeon makes a pouch shaped like the letter J from part of the ileum. The surgeon then joins the pouch with the anus. To give the pouch time to heal, you continue to pass stool through the ileostomy.
• Stage 3. After 2 to 3 months, the surgeon makes sure the J-pouch has healed. Then the surgeon closes the ileostomy. Stool passes out of the body through the J-pouch.

After the procedure

After the first surgery, you spend a brief time in the hospital to heal and learn how to care for your ileostomy. The result of the ileostomy is the end of the small intestine coming through a hole in your belly wall. You need to wear an ostomy bag outside your body until you have the third surgery. The bag collects stool.

If you have an ostomy bag, your care team teaches you how to empty it, change it and protect the skin around the stoma.

Your care team may tell you to drink a lot of fluids. Water or drinks that replace certain minerals, called electrolytes, help keep you from getting dehydrated.

You may get pain medicines or antibiotics after the surgery. Your care team may suggest antidiarrhea medicines or fiber supplements.

After surgery, don't lift anything or do activities that strain the body for about four weeks. After that, being active can help the healing process. Most often you can return to the activities you did before surgery.

Most people who have J-pouch surgery report a good quality of life and are happy with the results.

Within a year after J-pouch surgery, most people have fewer bowel movements than they did right after surgery. Most people have 5 to 6 bowel movements a day and one or two at night.

Diet and nutrition

There's no special diet for people who have had J-pouch surgery. But some foods, such as beans and cabbage, may cause gas or loose stool. Alcohol may do the same.

You might try to eat small amounts of foods you like to see how they affect you. Note how the food affects how often you pass stool and whether you have gas or discomfort.