Patients with chronic ulcerative colitis may feel helpless when medications fail to control their condition. A two-part surgery could help restore a patient’s lifestyle.
J-pouch surgery is a type of procedure used for ulcerative colitis (UC), a chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation and ulcers on the inner lining of the large intestine.
Is surgery an option for ulcerative colitis?
The initial surgery involves the removal of both the rectum and colon, preserving the anal area. A portion of the small intestine is used to create a J-shaped pouch to collect and aid in waste removal, which is then connected to the preserved anus. A temporary ileostomy is made to protect the pouch. After the patient heals, an ileostomy closure surgery takes place.
“Surgery is indicated for patients who need the colon and rectum removed. Typically these are patients with ulcerative colitis and familial polyposis syndromes,” said Dr. Timothy Wengert, a Marshfield Clinic Health System colorectal surgeon.
Ulcerative colitis can develop at any age, but the disease is more likely to develop in people between the ages of 15 and 30. In order to have an ileal pouch procedure, a patient’s intestinal muscles, sphincter, nerves and anus must still be able to function normally. This allows the patient to maintain control of bowel movements once a pouch is constructed.
According to Dr. Wengert, patients with colitis require surgery when their inflammation cannot be controlled with medication or if they develop a complication such as bleeding or infection. Polyposis patients have a risk for cancer developing in their colon and rectum unless the large bowel is removed.
“Historically, polyposis patients would have their colon and rectum removed resulting in a permanent ileostomy,” Wengert said. “Ileal pouch surgery avoids a permanent ileostomy by preserving the anus and reconnecting the small intestine to that area after the colon has been removed.”
After ileal pouch surgery for colitis
Patients can expect to spend five to seven days in the hospital after the first surgery followed by four to six weeks to regain stamina and strength. The pouch is checked for leakage following recovery. An ileostomy closure surgery occurs if no leakage is found. The second surgery typically requires patients to be hospitalized two to three days with up to a month to recover.
“Most patients go through this two-stage operation. However, some rare patients do not need the temporary ileostomy while some other patients who are quite ill are operated on in three stages,” Wengert said. The three-stage operation includes removal of the diseased colon but leaving the rectum and performing an ileostomy. A second surgery then follows to remove the rectum, take down the ileostomy to create the pouch followed by a third surgery to close the temporary ileostomy.
Living with ulcerative colitis
Frequent trips to the bathroom, even in the middle of the night, are common for patients with UC after surgery.
“After healing from the surgery, there is still an adjustment period regarding the bowel function. Patients will have an increase in stool frequency initially, which will then gradually adjust,” Wengert said.
Patients with UC do not have the luxury of delaying going to the bathroom.
“When colitis patients have to go to the bathroom, they have to ‘right away’ or they will have an accident. The lifestyle after surgery is acceptable to patients, especially given the alternative of a permanent ileostomy,” Wengert said. “They can eat and do whatever they wish. About 5% of patients will have problems and end up needing to have the pouch removed. That is typically for a finding of Crohn’s disease later on.”
Is surgery right for you?
“The vast majority of patients are quite satisfied with the results,” Wengert said. “Those few who aren’t, typically have problems such as higher stool frequency or incontinence. They also have a risk for pouchitis, an inflammation in the pouch that leads to diarrhea. It is treated successfully with antibiotics but some have chronic or recurrent pouchitis that ultimately leads to loss of pouch.”
Talk to your doctor if you have been diagnosed with or have concern about ulcerative colitis.
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