Ileoanal anastomosis (il-e-o-A-nul uh-nas-tuh-MOE-sis) surgery (commonly called J-pouch surgery) allows you to eliminate waste normally after removal of the upper and lowest parts of the large intestine (colon and rectum). J-pouch surgery is also known as ileal-pouch anal anastomosis (IPAA) surgery. The procedure avoids the need for a permanent opening in the abdomen (stoma) for passing bowel movements.

Ileoanal anastomosis is most often used to treat chronic ulcerative colitis and inherited conditions such as familial adenomatous polyposis (FAP) that carry a high risk of colon and rectal cancer. In some instances, the procedure is done when medications used to treat ulcerative colitis fail to control the condition. Ileoanal anastomosis is also sometimes used to treat colon cancer and rectal cancer.

When possible, surgeons perform J-pouch surgery using minimally invasive methods. Instead of opening the abdomen with a relatively large incision, they typically make more than one smaller abdominal incision through which surgical instruments and a long, narrow tube with a camera at its tip (laparoscope) can be inserted.

During the procedure, the surgeon will:

  • Remove the entire colon and rectum, preserving the muscles (sphincter) and opening (anus) at the end of the rectum.
  • Construct a pouch shaped like the letter J from the end of the small intestine and attach it to the anus (opening at the end of the rectum).
  • Construct a temporary opening in the abdominal wall (ileostomy) for eliminating waste.
  • Remove the ileostomy a few months later. Then you can pass bowel movements through the anus, with only a slight increase in bowel movement frequency.

After about 3 months of healing, the surgeon does a second procedure to close the ileostomy, allowing you to pass stool normally.


The most common complication of ileoanal anastomosis is pouchitis, an inflammation of the newly constructed pouch lining. The risk of pouchitis increases the longer the J pouch is in place, and also if you smoke or have arthritis or certain skin diseases.

Pouchitis can cause symptoms similar to those of ulcerative colitis, including diarrhea, abdominal and joint pain, fever, and dehydration. Contact your doctor if you experience any of these symptoms. In most cases, doctors can treat pouchitis with antibiotics.

Sometimes pouchitis doesn't respond to treatment. Then surgeons may need to remove the pouch and construct an ileostomy.

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 may affect fertility. Mayo Clinic experts will discuss the options with prospective parents.

What you can expect

During the ileoanal anastomosis, or J-pouch, surgery, the surgeon will remove the entire upper and lowest part of the large intestine, called the colon and rectum. They'll keep the muscles and opening at the end of the rectum. They'll make a pouch shaped like the letter J from the end of the small intestine and attach it to the opening at the end of the rectum.

They'll make a temporary opening in the wall of the abdomen for removing waste. They'll close the opening a few months later. Then you can pass bowel movements normally, with only a slight increase in bowel movement frequency. Most people can return to their normal activities, like work and sports, after this surgery.

Ileoanal anastomosis (J-pouch) surgery care at Mayo Clinic

Dec. 12, 2018
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Ileoanal anastomosis (J-pouch) surgery