Chances are if you have been stricken with ulcerative colitis or a condition known as familial adenomatous polyposis (FAP), then you have probably also heard of the term J-Pouch. Medically, a J-Pouch is made out of a patient’s small intestine and gets connected to the patient’s rectal canal after removal of the rectum and colon.
The procedure itself is known as a “Total proctocolectomy with or without ileal
J-pouch anal anastomosis “and usually presents itself during childhood.
Ileoanal Anastomosis Techniques
There are two techniques currently available for ileoanal anastomosis and they are either by stapling via extrarectal dissection or by being hand-sewn via endorectal mucosectomy. Through endorectal mucosectomy it is believed to be able to remove a huge amount of diseased tissue and eliminate the amount of cancer, inflammation, or dysplasia that may remain. Regardless, there will always be risk that remains after mucosectomy. Not only that, but mucosectomy has not been shown to be able to eliminate any likelihood of neoplasia to occur in the pouch.
For an anastomosis that is stapled, the surgeon utilizes extrarectal dissection for proctectomy, which is able to maintain some anorectal mucosa in the area. Either a single or dual staple gets used in order for the anastomosis to be formed. With some of the anorectal mucosa being maintained, sensation in the anal region is able to be improved. This also improves the feeling of being able to eliminate waste, and allows the patient to regain their anal sphincter function.
The J-Pouch
Although there is more than one pouch that can be created, an ileal pouch is created the most during surgeries. With the shape of a “J”, its body includes two attachments known as the efferent and afferent limbs as well as a ‘U’ turn shape. When an endoscopy is performed, a healthy looking J-Pouch should appear as an eye of an owl, as the inlet of the pouch as one and the “J” dome as the other.
The Colonic J-Pouch
With a colonic J-Pouch, the surgeon uses a similar technique that is seen with ilial J pouches; however the colonic J-Pouch has to be a smaller size. The surgeon will use diverticula from the colon in order to create the pouch itself. As it’s constructed it must be assured that it reaches the distal rectal. There needs to be at least 6 cm measured in order for the efferent limb to be formed. The efferent limb then gets overlapped on the colon in order to be close to the borders of the anti-mesenteric.
What Function Does the J-Pouch Serve?
The function of the J-Pouch is to store the bodily waste that circulates through the intestine after digestion and absorption are complete. Not only that, but it also helps dispose of the waste. This enables a patient to have a bowel movement the same way as they could before.
What are the Requirements for a J-Pouch?
For a patient to be eligible for the J-Pouch procedure they must exhaust all other forms of treatment for their ulcerative colitis. Patients who commonly undergo this surgery include those with:
• Therapies that have faileed
• Familial Adenomatous Polyposis
• Ulcerative colitis that is chronic
J-Pouch Benefit
No need for an ostomy – Having a J-Pouch does not need ostomy supplies or stoma pouches. This will save a lot of money on supplies as well as producing comfort emotionally and psychologically. It also restores bowel control until you are able to relieve yourself.
During the healing process, you need to be aware that your body will need to adapt to the J-Pouch. During this time you may experience an increase in trips to the toilet or decreased amount of stimulation during intercourse.
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