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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.

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.

Review Date: 1/26/2009
Reviewed By: Robert A. Cowles, MD, Assistant Professor of Surgery, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.