A j-pouch, or ileal pouch reconstruction, is a complex type of surgery used for people who have ulcerative colitis, particular types of colon cancer, and familial polyposis. Developed in the 1970s, this surgery eliminates the need for an external pouch to collect waste. The procedure can be performed in one, two, or three steps, but is most often done in two.
The first step is removal of the colon, or large intestine. The rectal muscles are left in place, but the lining of the rectum is removed. The surgeon will then create the actual pouch out of the small intestine. This pouch can be constructed in a few different ways to create a j-pouch, an s-pouch, or a w-pouch. The surgeon will decide on which type is appropriate for the patient. The pouch is then connected to the anus.
Finally the surgeon creates an ileostomy, which will be temporary while the j-pouch heals. An ileostomy is a procedure in which a part of the small intestine is brought through the skin of the abdomen. This external piece of the small intestine is called a 'stoma', which is Greek for 'mouth'. Waste exits the body through the stoma, and is collected by an ileostomy bag that is worn on the side of the abdomen. The ileostomy keeps stool from passing through the j-pouch, so that it is given time to heal.
After the patient has had time to heal (usually two or three months), the second step of the procedure will be performed. During this step, also called a takedown, the ileostomy is removed and the j-pouch is connected. The patient will no longer need the external ileostomy bag, and waste will be passed through the rectum.
One Step and Three Step Procedures
Occasionally, a surgeon and patient will decide to complete the entire procedure in one step. The surgeon will perform the colectomy, create the j-pouch and connect it all in one operation. The one step eliminates the need for a second surgery, or a temporary ileostomy.
If a patient is very ill, the surgeon may elect to use three steps to complete the procedure. In the first step, the colectomy is done, and the temporary ileostomy is created. In the second step, the j-pouch is constructed, and the third step is the takedown. The wait between each of these surgeries is two to three months, depending on the health of the patient.