J-Pouch ( Also called IPAA- internal pouch-anal anastomosis)


This sounds very grand, and that is because it really is an amazing innovation for many people who needed to have stoma surgery but also may be able to have a reversal. It was first performed here in the UK in the 1970’s.

I unfortunately am not one of those people who can have a reversal. This is because my rectum and anus were severely damaged by the colitis and needed to be removed,( so much so that I couldn’t have it removed when I had the original surgery as it wouldn’t have healed due to my poor nutritional state at the time) it wasn’t strong enough and healthy enough to be used again. As it happens the stitches, that were done to close the rectum off, burst causing rectal stump blowout and then sepsis, again due to me being very ill prior to surgery.

The procedure for reversal  is usually done around six months after an ileostomy give or take. Usually the whole colon and rectum have been removed and about 12 inches of small bowel is used to form a pouch very much like the old rectum , which is attached to the anus. While the pouch is healing the patient still has the stoma but the stoma is normally a loop stoma. ( Excuse the following dodgy sketches, but you get the idea). The loop usually has two holes instead of one because they cut the ileostomy at the top so when it bends the two tube openings are outside of the body.

LOOP ILEOSTOMY

 

 

 

 

END ILEOSTOMY 

 

 

As you can see from the diagram a loop ileostomy can be put back together again easily and tucked back inside.  An end ileostomy is totally cut and put through the skin.

After so many weeks a further operation is performed called the takedown, this involves the takedown of the ileostomy so that the internal pouch can start to work.

The name J-pouch is because the pouch looks like a J. 

The bit at the bottom is the anus.

 

 

 

For many people this procedure has been a godsend. Young adults who thought they may need a stoma forever can lead a near normal life. There are some issues that can occur, pouchitis is inflammation of the internal pouch which can make you very poorly, and can sometimes lead to more problems . Antibiotics are normally given and they can work well for most. But there are people who continue to have issues and are then offered surgery to get the stoma back. As you can imagine this is vey upsetting when you thought you had survived a very difficult surgery in order to get some normality back, and after all that stress of more major surgery you are back to where you were.

If all goes well then life can be good, with no stoma worries ,but it can still be a while before things are fully settled. You find you may need the toilet many times at first, even in the night, and wonder if you have done the right thing having the reversal in the first place. But after a while it settles down and the pouch starts to work like a rectum again.

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