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Reconstructive Pouch Surgery

Reconstructive pouch surgery is a surgical technique used for patients who have needed to have part or all of their large intestine removed as a result of injury or as a result of Ulcerative Colitis, Crohn’s Disease, cancer of the colon or a number of other serious conditions affecting the bowels.

It is an alternative to an external bag or pouch (such as a colostomy or ileostomy bag) for collecting waste. The procedure involves creating an internal pouch which is placed where the rectum would normally be by sewing or stitching together a number of sections of the small intestine (the ‘ileum’). The patient is then able to go to the toilet normally, that is faeces is passed normally via the anus, instead of collecting in an external pouch.

The full medical term for this procedure is ‘ileal pouch-anal anastomosis’ (sometimes shortened to IPAA), also referred to as ‘oleo-anal pouch’ or ‘restorative proctocolectomy’. There are also several slightly different techniques in use, such as ‘j-pouch’, ’s-pouch’, ‘w-pouch’ or ‘Kock pouch’.

Depending on the circumstances and the condition/s being treated, reconstructive pouch surgery may entail anything up to three separate operations, or it may be completed with one. In some cases, after construction of the pouch, the patient may need to wear an external pouch for a period to allow the internal pouch too heal and to avoid the possibility of infection.

Reconstructive pouch surgery may also in some circumstances be offered to patients who already wear an external pouch and who are suitable for surgery to create an internal pouch.

As with any surgery to remove sections of or all of the colon, patients generally need to make changes to their diet afterwards, both in terms of what is eaten and when food is eaten, although in general there are fewer dietary restrictions than those imposed by the original condition, and most patients are able to maintain a fairly normal and varied diet post surgery.