The type of Inflammatory Bowel Disease (IBD) that leads to the inflammation in the lining of colon and rectum is called Ulcerative Colitis.
Mostly the patient with ulcerative colitis doesn’t need a surgery .But people who have been suffering from UC for 30 years or more need a surgery.
It has been studied and observed by Crohn’s and Colitis foundation that J pouch is the only procedure in which ulcerative colitis does not react with any medication.
This article will basically tell you how J pouch actually works for UC and what to expect after and before the surgery among the risks and benefits.
What actually a J-pouch is, and what is it’s the working mechanism?
Another name for J-pouch is protocolectomy with ileal-anal anastomosis (IPPA).
After the removal of large intestine (Colon and rectum), the surgeon creates a J-pouch in the body. Just after the removal of large intestine, the surgeon folds small intestine into J shape. This pouch helps to collect the waste, which is then connected with anus, the opening of rectum.
A pair of sphincter muscles that surrounds the rectum remains in the same position even after the surgery. These muscles allow controlling the feces.
The anus also remains on its place even after the surgery. There is no need for long term ostomy pouch or stoma, if a person has gone through the J-pouch procedure.
What happens during the surgery?
The surgery mainly consists of two to three processes.
In the beginning, the surgeon removes the rectum and colon leaving the anus and the sphincter on their place. Then they use small intestine and convert one of its end into a J shape pouch, and then attach it to the anus.
The first process is termed as ileostomy. In this surgery, a hole is created in the wall of abdomen and one end of small intestine is connected to the opening of this hole. This aids feces to reach the ostomy bag; meanwhile the sphincter and small intestine are under healing process.
The second procedure is performed after 8 to 12 weeks of the first surgery .In this operation the ileostomy is reversed by using small intestine and connecting it back. This will allow the normal bowel movement.
In some cases surgeons needs to perform surgeries in three different steps:
Removing of colon and forming ileostomy
Removing of rectum and formation of J –pouch with the help of small intestine.
Reconnecting the intestine and reversal of ileostomy
The people with following issues have higher chances to have three surgeries:
Poor health conditions
An emergency case that needs to stop the bleeding
Toxic megacolon
Taking high dose steroids
What happens after the surgery?
A patient needs to be in hospital for the recovery and in order to learn the basic care for UC.
After the second and third procedure, a patient will need a short stay at the hospital till the doctors allow him to leave.
The signs that are observed by the patients during healing are:
Diarrhea
More number of bowel movements, which is due to loose feces
More urging need to pass feces at night
Tiredness, which will get better with healing time.
Blood seen in feces
Loss of water (Dehydration)
Every surgery has some risks. The risks that are associated with J-pouch surgery are:
Fastulas and pelvic abscesesses
Failure to make a pouch
Defect in pouch orientation
Pouchitis
It is also reported by American College of Gastroenterology that may be hard for a patient to conceive or get pregnant naturally, following this surgery.
Pouchitis is the most known issue. It can be treated by completing a course of antibiotics.
If the surgery is performed by an expert and an experienced surgeon then there are less chances to have any other complexities.
Advantages:
J-pouch procedure frees a person from life time need for an ostomy bag. Psychologically, it’s also beneficial to pass feces normally through the anus instead of the stoma.
It also does not have any significant effect on the current medication of the patient. Many people will feel a reasonable reduction in the pain level, urgency to pass stool, and diarrhea.
Conclusion:
J-pouch surgery basically involves formation of a colon by folding small intestine into a j-shaped pouch, with the removal of large intestine. This surgery allows a person to pass out feces normally and significantly reduces the discomfort levels and pain. It’s a very common and reliable procedure for the patients who are under a stress regarding their ileostomy.
