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 sleep 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
  • Risks
  • Before the Procedure
    • Always tell your health care provider what drugs you are taking, even drugs, 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 drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), Naprosyn (Aleve, Naproxen), and others.
      • Ask which drugs you should still take on the day of your surgery.
      • If you smoke, try to stop. Ask your provider for help.
      • Always let your provider 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 a certain time.
      • Follow the instructions you have been given about when to stop eating and drinking.
      • Your 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 drugs 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
    • 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: Elsevier Saunders; 2010:chap 113.

      Cunningham D, Atkin W, Lenz HJ, Lynch HT, Minsky B, Nordlinger B, et al. Colorectal Cancer. Lancet. 2010;375:1030-47. PMID: 20304247

      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. 19th ed. Philadelphia, PA: Elsevier Saunders; 2007:chap 52.