What Is an Ileoanal Anastomosis (J-Pouch) Surgery?

Reviewed on 7/17/2020

What is an Ileoanal anastomosis (J-pouch) surgery?

An ileal pouch-anal anastomosis (J-pouch) is a surgical procedure to restore the stomach and bowel (gastrointestinal) continuity after the surgical removal of the large bowel (the colon and rectum). 

An ileal pouch-anal anastomosis (J-pouch) surgery restores the stomach and bowel continuity after the surgical removal of the large bowel (the colon and rectum).
An ileal pouch-anal anastomosis (J-pouch) surgery treats the stomach and bowel.

Many conditions, including inflammatory diseases, cancer or infection, may necessitate the complete surgical removal of the colon and rectum.

  • The procedure involves the creation of a pouch of the small bowel to recreate the removed rectum (the part of the large bowel above the anus). 
  • Two or more loops of bowel are surgically stitched (sutured) or stapled together to form a reservoir for stool
  • This reservoir is then attached to the anus to eliminate waste normally after the removal of the entire large bowel. 
  • The Ileoanal anastomosis (J-pouch) is often protected by temporarily diverting the path of stool through a temporary opening on the abdomen (ileostomy). 
  • After recovery, this ileostomy is reversed during a separate procedure.

Who needs an Ileoanal anastomosis (J-pouch) surgery?

The J-pouch surgery is performed after the large bowel (the colon and rectum) has been completely removed. It is performed under the following conditions:

What happens in an Ileoanal anastomosis (J-pouch) surgery?

The following will help you understand what to expect during an ileal pouch-anal anastomosis (J-pouch) surgery.

Before the surgery

Your doctor may:

  • Order some blood tests and imaging studies (such as ultrasound, computed tomography [CT] and magnetic resonance imaging [MRI])
  • Ask you about any chronic health conditions
  • Ask you about any medications you are on
  • Ask about any allergies you may have
  • Explain the surgical procedure in detail, including possible complications, and address your doubts and concerns related to the surgery
  • Obtain your written consent
  • Ask your permission to perform a bowel preparation to clear the colon of waste, thereby reducing the bacterial load and chances of complications. This is usually done the day before the surgery with 4 L of a polyethylene glycol electrolyte solution or 300 mL of a magnesium citrate solution.
  •  Ask you to maintain a clear liquid diet the day before the surgery and to not eat or drink anything for 8-12 hours before the surgery

During the surgery

  • You will be asked to wear a hospital gown.
  • You will lie on your back in the lithotomy position (legs in stirrups or “frog-leg" position).
  • The anesthesiologist will administer general endotracheal anesthesia (general anesthesia with the airway protected using a breathing tube).
  • This surgery is usually performed in two stages.
  • The first surgery removes the colon and rectum. 
  • The second part involves the ileum (small bowel) being made into a J-shaped pouch and connected to the top of your anal canal.
  • A temporary ileostomy is performed to give your newly formed pouch a chance to heal. A loop of your small bowel will be pulled through an opening in your abdomen, called a stoma, to allow waste to exit your body into a stoma bag.
  • A second surgery may be performed 8-12 weeks later.
  • The second surgery reverses the ileostomy and reconnects your small bowel to the pouch.
  • The internal pouch collects waste and allows stool to pass through your anus in a bowel movement.

After the surgery

  • You may have an increased number of bowel movements, sometimes up to 12 times per day. This generally decreases over time.
  • You should discuss sexual functions with your surgeon and ask when it is safe to resume sexual activity.
  • You may ask your nurse or doctor what supplies you may need at home, especially if you will have a temporary ileostomy.
  • Your nurse or doctor will teach you how to manage the ileostomy and how to keep it clean.


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