Total proctocolectomy and ileal-anal pouch
Restorative proctocolectomy; Ileal-anal resection; Ileal-anal pouch; J-pouch; S-pouch; Pelvic pouch; Ileal-anal pouch; Ileal pouch-anal anastomosis; IPAA; Ileal-anal reservoir surgeryTotal proctocolectomy and ileal-anal pouch surgery is the removal of the large intestine and most of the rectum. The surgery is done in one or two stages.
Description
You will receive general anesthesia before your surgery. You will be asleep and unable to feel pain.
General anesthesia
General anesthesia is treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery. After you receive the...
Read Article Now Book Mark ArticleYou may have the procedure in one or two stages:
- Your surgeon will make a surgical cut in your belly. Then your surgeon will remove your large intestine.
- Next, your surgeon will remove your rectum. Your anus and anal sphincter will be left in place. The anal sphincter is the muscle that opens your anus when you have a bowel movement.
- Then your surgeon will make a pouch out of the last 12 inches (30 centimeters) of your small intestine. The pouch is sewn to your anus.
Some surgeons perform this operation using a camera. This surgery is called laparoscopy. It is done with a few small surgical cuts. Sometimes a larger cut is made so the surgeon can assist by hand. The advantages of this surgery are a faster recovery, less pain, and only a few small cuts.
If you have an ileostomy, your surgeon will close it during the last stage of the surgery.
Why the Procedure Is Performed
This procedure may be done for:
- Ulcerative colitis
Ulcerative colitis
Ulcerative colitis is a condition in which the lining of the large intestine (colon) and rectum become inflamed. It is a form of inflammatory bowel ...
Read Article Now Book Mark Article - Familial polyposis
Familial polyposis
A colorectal polyp is a growth on the lining of the colon or rectum.
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Risks
Risks of anesthesia and surgery in general are:
- Reactions to medicines
- Breathing problems
Breathing problems
Breathing difficulty may involve:Difficult breathing Uncomfortable breathingFeeling like you are not getting enough air
Read Article Now Book Mark Article - Bleeding, blood clots
Blood clots
Blood clots are clumps that occur when blood hardens from a liquid to a solid. A blood clot that forms inside one of your veins or arteries is calle...
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Risks of having this surgery include:
- Bulging tissue through the cut, called an incisional hernia
Incisional hernia
A hernia is a sac formed by the lining of the abdominal cavity (peritoneum). The sac comes through a hole or weak area in the strong layer of the be...
Read Article Now Book Mark Article - Damage to nearby organs in the body and nerves in the pelvis
- Scar tissue that forms in the belly and causes a blockage of the small intestine (this scar tissue is often called adhesions)
- The place where the small intestine is sewn to the anus (anastomosis) may come open, causing infection or abscess
Anastomosis
An anastomosis is a surgical connection between two structures. It usually means a connection that is created between tubular structures, such as bl...
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- Wound infection
Before the Procedure
Always tell your health care provider what medicines you are taking, even medicines, supplements, or herbs you bought without a prescription.
Before you have surgery, talk with your provider about the following things:
- Intimacy and sexuality
- Pregnancy
- Sports
- Work
During the 2 weeks before your surgery:
- Two weeks before surgery, you may be asked to stop taking medicines that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), Naprosyn (Aleve, Naproxen), and others.
- Ask which medicines you should still take on the day of your surgery.
- If you smoke, try to stop. Ask your provider for help.
Try to stop
There are many ways to quit smoking. There are also resources to help you. Family members, friends, and co-workers may be supportive. But to be su...
Read Article Now Book Mark Article - Always let your provider know about any cold, flu, fever, herpes breakout, or other illnesses you may have before your surgery.
Cold
The common cold most often causes a runny nose, nasal congestion, and sneezing. You may also have a sore throat, cough, headache, or other symptoms....
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The flu (influenza) is a viral respiratory illness that causes fever, chills, runny nose, body aches, and cough. It spreads easily from person to pe...
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Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
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The day before your surgery:
- You may be asked to drink only clear liquids, such as broth, clear juice, and water after a certain time.
- Follow the instructions you have been given about when to stop eating and drinking.
- You may need to use enemas or laxatives to clear out your intestines. Your provider will give you instructions on how to use them.
On the day of your surgery:
- Take the medicines you have been told to take with a small sip of water.
- You will be told when to arrive at the hospital.
After the Procedure
You will be in the hospital for 3 to 7 days. By the second day, you will most likely be able to drink clear liquids. You will be able to add thicker fluids and then soft foods to your diet as your bowel begins to work again.
While you are in the hospital for the first stage of your surgery, you will learn how to care for your ileostomy.
Outlook (Prognosis)
You will probably have 4 to 8 bowel movements a day after this surgery. You will need to adjust your lifestyle for this.
Most people recover fully. They are able to do most activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and most types of work.
References
Galandiuk S, Netz U, Morpurgo E, Tosato SM, Abu-Freha N, Ellis CT. Colon and rectum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 52.
Raza A, Araghizadeh F. Ileostomies, colostomies, pouches, and anastomoses. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 117.
Review Date: 8/22/2022
Reviewed By: Debra G. Wechter, MD, FACS, General Surgery Practice Specializing in Breast Cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.