Ileoanal anastomosis surgery (commonly called J pouch) allows you to eliminate waste normally after removal of the upper and lowest parts of the large intestine (colon and rectum). J-pouch surgery avoids the need for a permanent opening in the abdomen (stoma) for passing bowel movements.

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Ileoanal anastomosis is most often used to treat chronic ulcerative colitis and inherited conditions such as familial adenomatous polyposis that carry a high risk of colon cancer. Ileoanal anastomosis is also sometimes used to treat colon cancer and rectal cancer.

During the procedure, the surgeon removes the entire colon and rectum, while preserving the muscles (sphincter) and opening (anus) at the end of the large bowel. A pouch shaped like the letter J is constructed from the end of the small intestine and attached to the anus. An opening is constructed in the abdomen (ileostomy) for eliminating waste. The opening is temporary, to allow time for the pouch to heal. A few months later, a second operation removes the ileostomy. After that, you can pass bowel movements through the anus, with only slight increases in bowel movement frequency.

At Mayo, more than 75 percent of J-pouch procedures are done using minimally invasive surgery, which usually results in smaller incisions and a shorter hospital stay than conventional surgery. Surgeons at Mayo Clinic were also among the first to introduce completely laparoscopic and single-incision J-pouch procedures.

Most people can resume their normal activities, including work and sports, after J-pouch surgery. The surgery doesn't affect a woman's ability to have a normal pregnancy and delivery. But J-pouch surgery affects fertility, so Mayo Clinic experts will discuss the options with prospective parents.

The most common complication of ileoanal anastomosis is pouchitis, an inflammation of the newly constructed pouch lining. Pouchitis can cause symptoms similar to those of ulcerative colitis, including diarrhea, abdominal and joint pain, fever, and dehydration. The risk of pouchitis increases the longer the J pouch is in place, and also if you smoke or have inflammatory joint disease or certain skin diseases.

In most cases, pouchitis can be treated with antibiotics. When pouchitis doesn't respond to treatment, the pouch may be removed and an ileostomy constructed.

Mar. 16, 2012