Ileal Pouch Reconstruction Procedure
Ileal pouch reconstruction at UW Health in Madison, Wisconsin, has allowed patients with conditions such as ulcerative colitis, familial polyposis and certain types of colon cancer to avoid living with a permanent ileostomy and external appliance after colectomy.
Types of Pouches
The J- and S- reservoirs are the most common types of pouches used. The number of limbs and the amount of small bowel used to create them distinguishes the various types of pouches and reconstruction procedures.
The J-reservoir is made from two side-by-side limbs stapled together to create a J-loop. An S-reservoir has three limbs, with one serving as the ileal reservoir’s outlet. Function, capacity and elasticity vary with design. All reservoir types have similar functional results and stool frequency and are all viable options. Only during surgery can we determine which type of reservoir will work best.
Ileal pouch reconstruction is one of the most extensive and complex gastrointestinal procedures used today. The first part of the procedure involves removal of the colon and rectum. Next, we mobilize the small bowel's blood supply and mesentery (membranous tissue attaching the ileum to the body wall) to determine whether the ileum will reach the anal canal.
Most patients' small bowel will extend the necessary length, and we employ a variety of techniques to make the ileum reach the anal canal. In the unusual event that the small bowel does not reach, we may have to create a permanent ileostomy.
Creating the Pouch
Prior to pouch construction, we remove the anal canal lining, taking care to prevent injury to the anal sphincter. The pouch is then created using the design most appropriate for you.
After construction of the pouch, the reservoir outlet is sutured to the anal canal, and a temporary ileostomy is placed to protect the extensive anastomoses and allow the newly created pouch to heal. It is usually positioned slightly below and to the right or left of the navel. The enterostomal therapy nurse will work with you before the procedure to determine the best place for the ileostomy.
After approximately two months, you will return for ileostomy takedown. We remove the ileostomy, allowing the pouch to begin functioning on its own. Following the ileostomy takedown, normal ileal pouch function and bowel movements will begin. You will also have a small scar where the ileostomy used to be.