What is J-pouch Surgery?

There are two types of Inflammatory Bowel Diseases that affect the Gastrointestinal tract, which are Ulcerative Colitis and Crohn’s disease. Ulcerative Colitis, unlike Crohn’s disease does not affect just any part of the Gastrointestinal tract, instead it affect Only the large intestine (also known as Colon) and rectum.

J-pouch surgery is a procedure that is used to treat severe cases of Ulcerative Colitis only. There are situations when Gastrointestinal (GI) tract damage may be severe, and medications seem not to be working. In cases such as these, J-pouch surgery is recommended.

Apart from cases where medications are no longer working, J-pouch surgery can also be done when treating emergency, where the mega colon is toxic, or when there is an uncontrolled bleeding of the GI tract.

J-pouch surgery involves the removal of the rectum and Colon. Remember, Ulcerative Colitis (UC) affects only the rectum and Colon. In order to treat severe UC, the best option might be to remove the rectum and Colon. The surgeon will take a part of the small intestine to create a J-shaped pouch for easier collection and removal of waste.

Advantages of J-pouch surgery

Anyone who has suffered from an extensive damage of the GI tract will feel relieved after the procedure. Also, after the procedure, there will no longer be need for an ostomy (an external stool bag). You will not need to wear it because you will have a more natural control over your bowel movements.

However, there might still be need for you to use an ostomy temporarily, depending on the number of stages your surgery was performed.

The flip side of J-pouch surgery

You my still experience some UC symptoms like:

• Fatigue
• Stool inconsistency
• Bloody stools
• Abdominal pain

Who is J-pouch surgery for?

• When medications are no longer working
• Uncontrollable bleeding from the colon
• Want to use the use of an ostomy
• Chronic Inflammation that leads to holes in the colon
• When symptoms are getting worse

The J-pouch procedure

J-pouch surgery is done in 2-3 stages. These stages are scheduled 8-12 weeks apart.

First Stage

1. Removal of the rectum and Colon
2. The surgeon takes a portion of your small intestine (ileum), and uses it to form a J-shape – J-pouch.
3. After this, the surgeon allows the J-pouch to heal. Pending that time, the surgeon will create a temporary ileostomy (an opening in the abdominal wall). The purpose of this is to allow waste exit your body into an ostomy bag.

Second stage

After the J-pouch would have healed, the second stage can begin. It is about 2-3 months after the first Stage.

1. The surgeon disconnects the ileum from the temporary ostomy
2. Reconnects the ileum to the J-pouch created in the first Stage
3. After connecting, you can pass waste through your anus, naturally

Third stage

It is unusual, however, it is done where:

• You have toxic mega colon
• You’re taking steroids in high doses
• Emergency injury for bleeding 
• You are in poor health

Why stages?

It is done in stages to allow the J-pouch heal, and to prevent it from infection.

Recovery

• When using Ostomy, you need to keep it clean and empty, according to your doctor’s instructions.
• You may experience increase in bowel movements, and may pass waste up to 12 times a day. It reduces gradually
• You may need to wait for about 6 weeks (at least) before you can resume physical activity. Depending on how well your GI tract heals, you may need to wait go some time. Also, in case there are complications.

Risks and Complications

J-pouch surgery is considered a major surgery, hence there is a risk of infection, bleeding, and side effect from general anesthesia. Infection of the J-pouch is common in the first Stage of the procedure.

Some of the complications include:

• Pouch failure – where the J-pouch and your body fail to work together
• Small bowel obstruction – symptoms include abdominal pain, vomiting, and inability to pass waste.
• Pouchitis – inflammation and infection of the J-pouch. The risk of this is 50%.
• Phantom rectum- It is common. Where the patient experiences pains after the removal of the rectum.
• Infertility on women – if scar tissues grow around the fallopian tube and ovaries
• Sexual dysfunction – where there is a nerve damage. Happens to men and women.

Conclusion

The most common surgery for treating Ulcerative Colitis is the J-pouch surgery. It may be recommended in the case of emergency, and if other methods are not working out.

J-pouch surgery involves removing your colon and rectum. The small intestine is used to create a pouch to collect wayse. Some people prefer this to wearing an ostomy.

Even with these, it is advisable you discuss any potential risk and benefits of the procedure with your doctor.