Table of ContentsView AllTable of ContentsWhen It’s DoneCandidatesHow to Prepare for J-Pouch SurgeryWhat to Expect on the Day of SurgeryRecoveryFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
When It’s Done
Candidates
How to Prepare for J-Pouch Surgery
What to Expect on the Day of Surgery
Recovery
Frequently Asked Questions
J-pouch surgery, also known as the ileal pouch-anal anastomosis(IPAA) procedure, is a complex treatment for severe disease or injury affecting thelarge intestine(colon).
J-pouch surgery (often, a series of surgeries) is designed to remove the damaged tissue of the colon and allows the patient to continue to have“normal” bowel movements, meaning stool leaves the body through the anus.
This article explains why J-pouch surgery is used as an alternative toileostomy, which creates an artificial pathway for passing stool. It will help you to better understand the J-pouch procedure and what to expect.
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What Is J-Pouch Surgery?
In cases where the colon is extensively diseased and/or damaged, its removal may be necessary.
When removal of the colon is necessary, you have two options for treatment: J-pouch surgery or anileostomy. The J-pouch is a small pouch formed from the end of the small intestine into a J shape where stool can wait until it is time for a bowel movement.
The muscular J-pouch can not only store stool until it is time for a bowel movement, but you will have some or total control over the timing of the bowel movement.
The rectum is removed during the J-pouch procedure, but in many ways, the J-pouch is a surgically created rectum. It allows for stool to continue to pass through the anus.
J-Pouch vs. Ileostomy
With an ileostomy, stool travels from the small intestine through an incision in the body and into an appliance that is outside of the body. This appliance adheres to the skin and has a removable bag where stool can collect and then be discarded.
Many people choose J-pouch surgery because they do not want to have an ileostomy long-term, saying that the device is uncomfortable or unsightly. Some complain that there is an odor or that the ileostomy interferes with sexual intimacy, irritates the skin, or is generally annoying.
J-pouch surgery has multiple names depending on the stage of surgery and the country in which it will be performed. In addition to the ileal pouch-anal anastomosis, J-pouch surgery is sometimes called:Ileo-anal pouchIleo-anal reservoir (IAR)Internal pouchRestorative proctocolectomyIleal-anal pull-throughKock pouchIleostomy takedown
J-pouch surgery has multiple names depending on the stage of surgery and the country in which it will be performed. In addition to the ileal pouch-anal anastomosis, J-pouch surgery is sometimes called:
The Differences Between an Ileostomy and a J-Pouch
Purpose of J-Pouch Surgery
Acolon-rectal surgeonwill be the final decision-maker on whether or not a patient is a candidate for the J-pouch procedure. That decision will be based on many factors, including:
In general, to be a candidate for the J-pouch procedure, the patient must have severe colon disease or damage. Trauma would be a reason for damage that is treated surgically, such as a gunshot wound to the abdomen that causes significant injury to the large intestine.
Medically,ulcerative colitisis the most common reason for the J-pouch procedure.
Colon cancer is a common reason for the colon to be removed.Familial adenomatous polyposis, or FAP, almost always leads to colon cancer and is a common reason for J-pouch surgery.
Causes and Risk Factors of Colon Cancer
Contraindications
Whether J-pouch surgery is the right choice will depend on more than the condition of the colon alone. For example, a patient who has severe ulcerative colitis that does not respond to medication, which is the most common reason for the procedure, may not be a candidate for surgery.
Some people have underlying health issues that rule out surgery, such as a heart condition that could make anesthesia too risky or diabetes that is too poorly controlled.
Treating knownCrohn’s disease— which differs from colitis in that the ulcerative lesions can appear in areas other than the colon — with J-pouch surgery is controversial.
This is because it is possible to remove the colon and create the J-pouch only to find that the J-pouch develops new ulcerative lesions, potentially leaving the patient worse off than when they started treatment.
Complications
In addition to the standard risks of surgery, including areaction to anesthesiaand well-known complications such as pneumonia or blood clots, there are additional risks that are specific to the ileostomy and J-pouch procedures. These risks include:
Keep in mind that these issues typically improve after surgery, as the patient learns the way their body functions after surgery and recovers fully:
First, be sure that your healthcare provider has made the J-pouch procedure clear to you. That’s because it can be completed all in one procedure, or in as many as three separate surgeries.The typical wait between each of these surgeries is two to three months, depending on the health of the patient.
Your surgical team will provide you with detailed instructions about the procedure, including:
J-Pouch Surgery and ChildrenChildren who need a J-pouch surgery may have just one procedure, especially if FAP is the reason. For ulcerative colitis, the procedure is done in two stages.
J-Pouch Surgery and Children
Children who need a J-pouch surgery may have just one procedure, especially if FAP is the reason. For ulcerative colitis, the procedure is done in two stages.
Ulcerative Colitis: Causes and Risk Factors
The J-pouch procedure is typically planned to be performed in two steps, meaning two separate surgeries will be performed often two to three months apart.
A temporary ileostomy is created between the two stages.It allows waste to pass through a stoma (opening). It is collected in an external pouch worn on the abdomen. The ileostomy diverts stool from passing through the j-pouch so that the pouch is given time to heal.
During the Surgery
In the first procedure, the colon is removed. The small intestine is separated from the large intestine, and an ileostomy is formed so stool can exit the body. The J-pouch is created at this point, but it will not receive any stool initially.
For several months after the first surgery, the newly formed J-pouch is allowed to heal and strengthen. Once the J-pouch is healed, an additional procedure is performed to allow stool to travel through the small intestine.
It passes into the J-pouch where it’s temporarily stored. Stool then exits the body through the rectum as it did prior to the initial surgery.
This two-surgery process is the most common method for a J-pouch procedure, but it can also be completed in one surgery. In those instances, an ileostomy is not performed. The colon and rectum are removed; the J-pouch is formed and connected to the rectal stump (the small remaining portion of the rectum just inside the anus) in the same procedure.
In some cases, surgeons perform surgery in three phases, but this is less common.
All steps of the procedure are performed under general anesthesia and typically result in a 3- to 7-day hospital stay, depending on the number of stages performed and the overall health of the patient.
These procedures are complex and difficult to truly understand without visual aids. For that reason, The Crohn’s and Colitis Foundation has created a video to clearly explain the J-pouch procedure.
After Surgery
After J-pouch surgeryhas been completed, it can be many months before you reach your “new normal” for bowel movements. This may seem very different from what’s considered normal for people without a J-pouch.
Things to expect:
After the recovery is complete, the average patient experiences five or six controlled bowel movements per day.
Your response to J-pouch surgery may depend on your previous symptoms, which may be improved in someone with ulcerative colitis. However, the consistency and frequency of stool may appear alarming if you’ve always had normal bowel movements but had the procedure to prevent cancer. Most people will adjust in time.
J-Pouch Surgery Recovery
Part of the recovery process will involve learning which foods and fluids can potentially aggravate your J-pouch and cause poorly controlled bowel movements. You may also need to continue using some medications to decrease diarrhea and increase bowel movement control.
Once post-J-pouch surgery dietary and medication needs are understood and the site is healed, people are usually satisfied with the results.
J-Pouch Surgery Diet
Between 10% and 20% of people are dissatisfied with their outcomes. In these cases, you may elect to have an ileostomy or another procedure after having the J-pouch procedure.
The staff at your surgeon’s office and theenterostomal therapy nurse(nurses who specialize in the care of ostomy and other wounds) can be of significant assistance when recovering. Do not hesitate to discuss any issues with these medical professionals as they have likely seen the problem before.
Summary
J-pouch surgery is an option for people living with ulcerative colitis and other conditions, including the genetic disorder FAP that greatly increases their risk of colon cancer. It involves removing part of the intestines and then reconnecting them to the rectum, so that stool passes through the anus.
It may be an alternative to a full ileostomy for some people. However, because most J-pouch surgeries involve two separate procedures, a temporary ileostomy is common during the interval so that the pouch heals and becomes strong.
Your healthcare team can discuss the risks and potential rewards of surgery with you. You’ll want to be sure you understand the procedure and its costs (they vary based on location, insurance coverage, and other factors), as well as what to expect during and after your recovery.
Frequently Asked QuestionsYes, according to one study, about 4% of J-pouch surgeries will fail. The majority happen within three years of surgery. The rate may be higher for different conditions. For example, about 11% of patients with Crohn’s disease experienced failure according to other research studies.Learn MoreTreatment Options for Crohn’s DiseaseThe surgeries needed for a J-pouch procedure may take between six and 10 hours each. This varies depending on your body size, severity of your condition, overall health, and if you’ve had previous surgeries.Yes, but there is a significant risk of infertility. About 40% of women have trouble conceiving after J-pouch surgery.This may be due to surgery causing blockages in the fallopian tubes.
Yes, according to one study, about 4% of J-pouch surgeries will fail. The majority happen within three years of surgery. The rate may be higher for different conditions. For example, about 11% of patients with Crohn’s disease experienced failure according to other research studies.Learn MoreTreatment Options for Crohn’s Disease
Yes, according to one study, about 4% of J-pouch surgeries will fail. The majority happen within three years of surgery. The rate may be higher for different conditions. For example, about 11% of patients with Crohn’s disease experienced failure according to other research studies.
Learn MoreTreatment Options for Crohn’s Disease
The surgeries needed for a J-pouch procedure may take between six and 10 hours each. This varies depending on your body size, severity of your condition, overall health, and if you’ve had previous surgeries.
Yes, but there is a significant risk of infertility. About 40% of women have trouble conceiving after J-pouch surgery.This may be due to surgery causing blockages in the fallopian tubes.
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.University of Pennsylvania Health System Division of Colon and Rectal Surgery.Patient and Family Guide to Ileal J-Pouch Anal Anastamosis (IPAA) Surgery.Schiller LR.Evaluation of chronic diarrhea and irritable bowel syndrome with diarrhea in adults in the era of precision medicine.Am J Gastroenterol. 2018;113(5):660-669. doi:10.1038/s41395-018-0032-9American Cancer Society.What Is an Ileostomy?.Crohn’s & Colitis Foundation.J-Pouch Surgery.Mozafar M, Shateri K, Tabatabaey A, Lotfollahzadeh S, Atqiaee K.Familial adenomatous polyposis: ileo-anal pouch versus ileo-rectal anastomosis.Gastroenterol Hepatol Bed Bench. 2014;7(4):206-10.Freeha K, Bo S.Complications Related to J-Pouch Surgery.Gastroenterol Hepatol (N Y). 2018 Oct;14(10):571-576. PMID: 30846911.Mège D, Figueiredo MN, Manceau G, Maggiori L, Bouhnik Y, Panis Y.Three-stage Laparoscopic Ileal Pouch-anal Anastomosis Is the Best Approach for High-risk Patients with Inflammatory Bowel Disease: An Analysis of 185 Consecutive Patients. J Crohns Colitis. 2016;10(8):898-904. doi:10.1093/ecco-jcc/jjw040Children’s Hospital of Philadelphia.J-pouch Surgery.Hicks CW, Hodin RA, Bordeianou L.Possible overuse of 3-stage procedures for active ulcerative colitis. JAMA Surg. 2013;148(7):658-64. doi:10.1001/2013.jamasurg.325University of California San Francisco.Special Concerns for People with J-Pouches.Freeha K, Bo S.Complications Related to J-Pouch Surgery.Gastroenterol Hepatol(N Y). 2018;14(10):571-576.Helavirta I, Lehto K, Huhtala H, Hyöty M, Collin P, Aitola P.Pouch failures following restorative proctocolectomy in ulcerative colitis.Int J Colorectal Dis. 2020;35(11):2027-2033. doi:10.1007%2Fs00384-020-03680-1UNC School of Medicine.J-Pouch Procedure.Ng KS, Gonsalves SJ, Sagar PM.Ileal-anal pouches: A review of its history, indications, and complications.WJG. 2019;25(31):4320-4342. doi:10.3748%2Fwjg.v25.i31.4320
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.University of Pennsylvania Health System Division of Colon and Rectal Surgery.Patient and Family Guide to Ileal J-Pouch Anal Anastamosis (IPAA) Surgery.Schiller LR.Evaluation of chronic diarrhea and irritable bowel syndrome with diarrhea in adults in the era of precision medicine.Am J Gastroenterol. 2018;113(5):660-669. doi:10.1038/s41395-018-0032-9American Cancer Society.What Is an Ileostomy?.Crohn’s & Colitis Foundation.J-Pouch Surgery.Mozafar M, Shateri K, Tabatabaey A, Lotfollahzadeh S, Atqiaee K.Familial adenomatous polyposis: ileo-anal pouch versus ileo-rectal anastomosis.Gastroenterol Hepatol Bed Bench. 2014;7(4):206-10.Freeha K, Bo S.Complications Related to J-Pouch Surgery.Gastroenterol Hepatol (N Y). 2018 Oct;14(10):571-576. PMID: 30846911.Mège D, Figueiredo MN, Manceau G, Maggiori L, Bouhnik Y, Panis Y.Three-stage Laparoscopic Ileal Pouch-anal Anastomosis Is the Best Approach for High-risk Patients with Inflammatory Bowel Disease: An Analysis of 185 Consecutive Patients. J Crohns Colitis. 2016;10(8):898-904. doi:10.1093/ecco-jcc/jjw040Children’s Hospital of Philadelphia.J-pouch Surgery.Hicks CW, Hodin RA, Bordeianou L.Possible overuse of 3-stage procedures for active ulcerative colitis. JAMA Surg. 2013;148(7):658-64. doi:10.1001/2013.jamasurg.325University of California San Francisco.Special Concerns for People with J-Pouches.Freeha K, Bo S.Complications Related to J-Pouch Surgery.Gastroenterol Hepatol(N Y). 2018;14(10):571-576.Helavirta I, Lehto K, Huhtala H, Hyöty M, Collin P, Aitola P.Pouch failures following restorative proctocolectomy in ulcerative colitis.Int J Colorectal Dis. 2020;35(11):2027-2033. doi:10.1007%2Fs00384-020-03680-1UNC School of Medicine.J-Pouch Procedure.Ng KS, Gonsalves SJ, Sagar PM.Ileal-anal pouches: A review of its history, indications, and complications.WJG. 2019;25(31):4320-4342. doi:10.3748%2Fwjg.v25.i31.4320
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
University of Pennsylvania Health System Division of Colon and Rectal Surgery.Patient and Family Guide to Ileal J-Pouch Anal Anastamosis (IPAA) Surgery.Schiller LR.Evaluation of chronic diarrhea and irritable bowel syndrome with diarrhea in adults in the era of precision medicine.Am J Gastroenterol. 2018;113(5):660-669. doi:10.1038/s41395-018-0032-9American Cancer Society.What Is an Ileostomy?.Crohn’s & Colitis Foundation.J-Pouch Surgery.Mozafar M, Shateri K, Tabatabaey A, Lotfollahzadeh S, Atqiaee K.Familial adenomatous polyposis: ileo-anal pouch versus ileo-rectal anastomosis.Gastroenterol Hepatol Bed Bench. 2014;7(4):206-10.Freeha K, Bo S.Complications Related to J-Pouch Surgery.Gastroenterol Hepatol (N Y). 2018 Oct;14(10):571-576. PMID: 30846911.Mège D, Figueiredo MN, Manceau G, Maggiori L, Bouhnik Y, Panis Y.Three-stage Laparoscopic Ileal Pouch-anal Anastomosis Is the Best Approach for High-risk Patients with Inflammatory Bowel Disease: An Analysis of 185 Consecutive Patients. J Crohns Colitis. 2016;10(8):898-904. doi:10.1093/ecco-jcc/jjw040Children’s Hospital of Philadelphia.J-pouch Surgery.Hicks CW, Hodin RA, Bordeianou L.Possible overuse of 3-stage procedures for active ulcerative colitis. JAMA Surg. 2013;148(7):658-64. doi:10.1001/2013.jamasurg.325University of California San Francisco.Special Concerns for People with J-Pouches.Freeha K, Bo S.Complications Related to J-Pouch Surgery.Gastroenterol Hepatol(N Y). 2018;14(10):571-576.Helavirta I, Lehto K, Huhtala H, Hyöty M, Collin P, Aitola P.Pouch failures following restorative proctocolectomy in ulcerative colitis.Int J Colorectal Dis. 2020;35(11):2027-2033. doi:10.1007%2Fs00384-020-03680-1UNC School of Medicine.J-Pouch Procedure.Ng KS, Gonsalves SJ, Sagar PM.Ileal-anal pouches: A review of its history, indications, and complications.WJG. 2019;25(31):4320-4342. doi:10.3748%2Fwjg.v25.i31.4320
University of Pennsylvania Health System Division of Colon and Rectal Surgery.Patient and Family Guide to Ileal J-Pouch Anal Anastamosis (IPAA) Surgery.
Schiller LR.Evaluation of chronic diarrhea and irritable bowel syndrome with diarrhea in adults in the era of precision medicine.Am J Gastroenterol. 2018;113(5):660-669. doi:10.1038/s41395-018-0032-9
American Cancer Society.What Is an Ileostomy?.
Crohn’s & Colitis Foundation.J-Pouch Surgery.
Mozafar M, Shateri K, Tabatabaey A, Lotfollahzadeh S, Atqiaee K.Familial adenomatous polyposis: ileo-anal pouch versus ileo-rectal anastomosis.Gastroenterol Hepatol Bed Bench. 2014;7(4):206-10.
Freeha K, Bo S.Complications Related to J-Pouch Surgery.Gastroenterol Hepatol (N Y). 2018 Oct;14(10):571-576. PMID: 30846911.
Mège D, Figueiredo MN, Manceau G, Maggiori L, Bouhnik Y, Panis Y.Three-stage Laparoscopic Ileal Pouch-anal Anastomosis Is the Best Approach for High-risk Patients with Inflammatory Bowel Disease: An Analysis of 185 Consecutive Patients. J Crohns Colitis. 2016;10(8):898-904. doi:10.1093/ecco-jcc/jjw040
Children’s Hospital of Philadelphia.J-pouch Surgery.
Hicks CW, Hodin RA, Bordeianou L.Possible overuse of 3-stage procedures for active ulcerative colitis. JAMA Surg. 2013;148(7):658-64. doi:10.1001/2013.jamasurg.325
University of California San Francisco.Special Concerns for People with J-Pouches.
Freeha K, Bo S.Complications Related to J-Pouch Surgery.Gastroenterol Hepatol(N Y). 2018;14(10):571-576.
Helavirta I, Lehto K, Huhtala H, Hyöty M, Collin P, Aitola P.Pouch failures following restorative proctocolectomy in ulcerative colitis.Int J Colorectal Dis. 2020;35(11):2027-2033. doi:10.1007%2Fs00384-020-03680-1
UNC School of Medicine.J-Pouch Procedure.
Ng KS, Gonsalves SJ, Sagar PM.Ileal-anal pouches: A review of its history, indications, and complications.WJG. 2019;25(31):4320-4342. doi:10.3748%2Fwjg.v25.i31.4320
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