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Total proctocolectomy and ileal - anal pouch

Definition

Total 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.

Alternative Names

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 surgery

Description

You will receive general anesthesia right before your surgery. This will make you unconscious and unable to feel pain.

During the first stage of surgery:

• Your surgeon will make an incision (cut) in your belly. Then your surgeon will remove your large intestine.
• Next your surgeon will remove your rectum. Your anus and anal sphincter (the muscle that opens your anus when you have a bowel movement) will be left in place.
• Then your surgeon will make a pouch out of the last 1 1/2 feet of your small intestine. The pouch is sewn to your anus.

In the second stage of surgery, you will often have a small cut made in the wall of your belly for an ileostomy. It is usually placed in the lower right part of your belly. The ileum is brought up to this spot and sewn into the abdominal wall.

If you have an ileostomy, your surgeon will close it later in a shorter surgery.

Why the Procedure Is Performed

This procedure may be done for:

• Ulcerative colitis
• Familial polyposis

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Heart attack or stroke
• Infection, including in the lungs, urinary tract, and belly

Risks for this surgery include:

• Damage to nearby organs in the body and nerves in the pelvis
• Wound infections
• Wound breaking open
• Bleeding inside your belly
• Bulging tissue through the incision, called an incisional hernia
• The place where your small intestine is sewn to your anus may come open. This is called anastomosis. It can be life threatening.
• Scar tissue may form in your belly and cause blockage of your small intestine.

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

Talk with your doctor or nurse about these things before you have surgery:

• Intimacy and sexuality
• Sports
• Work
• Pregnancy

During the 2 weeks before your surgery:

• Two weeks before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), Naprosyn (Aleve, Naproxen), and others.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor for help.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illnesses you may have before your surgery.
• Eat high fiber foods and drink 6 to 8 glasses of water every day.

The day before your surgery:

• Eat a light breakfast and lunch.
• You may be asked to drink only clear liquids, such as broth, clear juice, and water, after noontime.
• Do NOT drink anything after midnight, including water. Sometimes you will not be able to drink anything for up to 12 hours before surgery.
• Your doctor or nurse may ask you to use enemas or laxatives to clear out your intestines. They will give you instructions for this.

On the day of your surgery:

• Take your drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you 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. Your doctor or nurse will slowly add thicker fluids and then soft foods as your bowel begins to work again.

While you are in the hospital for the first stage of your surgery, your nurse and doctor will teach you how to care for your ileostomy.

Outlook (Prognosis)

Most people recovery fully. 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 who have a total abdominal colectomy recover fully. Most people 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

Cima RR, Pemberton JH. Ileostomy, colostomy, and pouches. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2006:chap 110.

Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 50.

Khatri VP, Asensio JA, eds. Subtotal colectomy/panproctocolectomy and j-pouch reconstruction. Operative Surgery Manual. 1st Ed. Philadelphia, Pa: Saunders; 2003:chap 35.

Scriver G, Hyman N. Ileostomy construction. Operative Techniques in General Surgery. 2007;9(1): 43-49.

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