Ileoanal Reservoir (Pouch) Surgery

The Ileoanal reservoir procedure is a surgical treatment option for chronic ulcerative colitis, colon cancer and polyposis patients who need their large intestine (colon) removed. This treatment eliminates the disease and avoids the need for a permanent opening in the abdomen for passing bowel movements.

Ileal pouch reconstruction (J-pouch) is done in one, two or three steps, but is most often done in two. The first surgery removes the entire large bowel (colon) and the lining of the rectum, but leaves the rectal muscle intact. A reservoir or “pouch” is made out of the small intestine and connected to the anus. A temporary ileostomy is made between the small bowel and the skin of the abdomen where stool and gas can be passed. The ileostomy diverts the stool so that the pouch can heal.

The second surgery is usually done 2-3 months later. It removes the ileostomy and reconnects the bowel. The pouch can then work. Waste goes into the pouch and is stored. When the person feels the urge to go to the bathroom the stool can be passed through the anus and out of the body. In most cases, the second surgery can be done at the ileostomy site without re-opening the first incision. The temporary ileostomy opening closes and heals.

After surgery

Stools start to pass through the anus and are frequent and liquid. There may be a feeling of urgency to go to the bathroom and there may be leakage of stool. Over time, as the anal sphincter muscles become stronger, the pouch adapts to its new function. Stools become thicker as the small intestine absorbs more water. Medicines to decrease bowel activity and make the stool more solid can also be taken.

Patients can help by avoiding foods that may cause gas, diarrhea and irritation. Careful skin care around the anus will protect the skin from the irritation that happens because of frequent stools. Continuing anal sphincter muscle exercises can help to strengthen these muscles.

After about 6 months, most people can expect to have 5 to 6 semi-formed bowel movements during the day and one at night. The pouch takes up to one year to fully function and improves over time.

Surgery considerations

Patients and their family members should get information about this surgery to understand what to expect during the course of the procedure and after the procedure. A gastroenterologist or surgeon can discuss these issues and stay in contact with the patient and family during the surgeries and throughout the rehabilitation process. Patients satisfaction with this surgery is high with both ulcerative colitis and familial polyposis.