J-Pouch
In the 1940's and 1950's, procedures that connected the small intestines directly to the anal sphincter often result in urgency (the sudden, unstoppable urge to defecate), frequency, and perianal skin breakdown. In the 1960's, Dr. Nils Kock created the continent ileostomy. In the 1980's, pelvic reservoirs procedures were introduced using the concept evolved from the continent ileostomy. The pelvic reservoir procedures are the closest to the natural way of eliminating fecal waste, by allowing passage of stool through the anal orifice.
How the J Pouch is Made
The pelvic reservoir, also know as the J, S, or W pouch, requires the usage of two feet of the small bowel to construct a pseudo-rectum. Once the colon and rectum are removed, preserving only the anus, the small intestines remain and have no capacity to store stool. To make a new reservoir, the small bowel is folded on itself and the adjacent bowel loops are sewn or stapled together. The operation may be performed laparoscopically, and in either one, two, or three steps, depending on the health of the patient, and health of the intestines.
Who is a Canidate For a J Pouch
Patients who have had ulcerative colitis or familial polyposis unresponsive to medication. This procedure can only be performed on patients who still have their anal canal intact. It is possible, that at the time of surgery, a J pouch can not be created for anatomical reasons. Should that occur, a Brooke ileostomy (requiring an external appliance) or a continent ileosotmy (internal pouch) may be performed at that time. Patients with damaged anal sphincters are not candidates for a J pouch. Those with other medical conditions that make anesthesia and surgery excessively risky or have Crohn's disease are not considered good candidates.
Post Operative
Should your surgery be in two or three steps, you will have a temporary ileostomy for 4-6 months, and then return to have the ostomy closed and the J pouch connected. Immediately postop, it is common to experience urgency, frequency and slight bowel incontinence. Once the pouch has healed and a chance to enlarge, approximately 3 to 9 bowel movements a day can be expected. The average is 6 times a day. There are no diet or activity restrictions.
Pros & Cons
The main advantage would be the ability to evacuate in the usually fashion of sitting and expelling from the anus. There is no need for supplies or catheters. Some patients experience "butt burn" in the fresh post op period. This is due to frequency and slight incontinence. This subsides after the adjustment period.
Symptoms of Complications
- Pouchitis: Urgency, frequency, painful straining, bleeding and incontinence. Responds well to antibiotics.
- Bowel obstruction: Nausea, vomiting, bloated, and unable to pass any stool. Early in recovery, this can be due to food if not chewed properly. Later, it is caused by adhesions that kink the small intestines. The majority of obstructions can be resolved without surgery.
- Pelvic infection: Fever, chills, lack of energy. The cause is a result of a leak where the bowel is newly connected. This occurs in about 6%of the patients and can be treated with antibiotics or by placing a drain in the site is infected.
- Stenosis: Feeling of incomplete emptying of the bowel or frequent urgent bowel movements. It is rarely a significant problem and can resolve by gentle dilation of the connection digitally or with dilators.
Center for Urinary and Intestinal Continence
St. Anthony's Hospital, Professional Office Building
1201 Fifth Ave. N., Suite 408
St. Petersburg, FL 33705
Call us at (866) 598-0001
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