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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.
You 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 (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.
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:
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:
- Bleeding inside your belly
- Bulging tissue through the cut, called an incisional hernia
- 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
- The place where the small intestine is sewn to the anus may come open (anastomosis), which can be life threatening
- Wound breaks open
- Wound infections
Before the Procedure
Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
Before you have surgery, talk with your doctor or nurse 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 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
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 noon.
- 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.
On the day of your surgery:
- Take the 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)
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
Cima RR, Pemberton JH. Ileostomy, colostomy, and pouches. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 113.
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.
Cunningham D, Atkin W, Lenz HJ, Lynch HT, Minsky B, Nordlinger B, et al. Colorectal cancer. Lancet. 2010;375:1030-1047.
Scriver G, Hyman N. Ileostomy construction. Operative Techniques in General Surgery. 2007;9(1): 43-49.
Reviewed By: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
