• Joel Bauer MD
  • Stephen Gorfine MD
  • David Chessin MD
  • Daniel Popowich MD

Restorative Proctocolectomy (J-Pouch)

Restorative Proctocolectomy

Manhattan Abdominal Surgeons

The diseases ulcerative colitis and familial adenomatous polyposis are historically treated by removing of the colon, rectum, and anus, making a permanent ileostomy bag necessary. Although patients do quite well following this procedure, many desire to treat their disease while continuing defecation in the normal way.

Restorative proctocolectomy was developed for the surgical management of ulcerative colitis and familial adenomatous polyposis to properly treat the diseases while maintaining normal defection. In a restorative proctocolectomy, the colon and rectum are removed. A J-shaped pouch is then created from the ileum, which is the end of the small intestine. The J-shaped pouch is then connected to the anus by sutures or staples.

Following the procedure, patients often have six to eight bowel movements per day with excellent control. Our practice has performed more than 1700 restorative proctocolectomies, more than most centers in the world, and this record can help you. Call 646.798.4606 for more information.

Diagnosis & Treatment

The first step to diagnose an issue includes a history and physical examination. The diseases are often diagnosed using colonoscopy with biopsy. During the colonoscopy, a small amount of tissue from the lining of the large intestine is removed and sent for pathologic examination. Other studies that may be used include plain abdominal X-rays and CT scan of the abdomen and pelvis. Radiologic studies are often used to evaluate for the complications of ulcerative colitis, including large intestine dilation and perforation.

In many cases, the initial treatment of ulcerative colitis includes medication administered by a gastroenterologist, including:

  • 5-ASA compounds such as mesalamine
  • Steroids
  • 6-MP/azathioprine
  • Cyclosporine
  • Remicade

Surgery may be recommended in patients unresponsive to medical management, who have intolerable side effects of the medication, or who have developed precancerous or cancerous lesions of the large intestine.

Surgery may be performed in one to three different procedures, depending on the reason for surgery and the clinical appearance of the patient. This includes:

  • First, in some situations, most of the colon is removed and a temporary ileostomy is performed
  • Following recovery, the remaining colon and rectum are removed
  • After removal, a permanent ileostomy is an option

However, most people are candidates for a restorative proctocolectomy (ileal J-pouch). A restorative proctocolectomy involves creating a pouch out of the end of the small intestine and connecting it to the anus. The result of this procedure is removal of the diseased large intestine with maintenance of the normal route of defecation.

For patients with familial adenomatous polyposis, surgery is recommended to prevent progression to an invasive cancer. There is no good medical treatment for the disease. Your surgeon will discuss the optimal timing of surgery with you, but it is often performed in the late teenage years to early twenties.

Preparation & Anesthesia

The night prior to the procedure, you will be instructed to take nothing to eat or drink after midnight. In addition, you will be prescribed a bowel preparation. The preparation should be taken as instructed.

For a restorative proctocolectomy, you will receive general anesthesia, in which you are completely asleep and monitored at all times by an anesthesiologist.

Operation

After anesthesia is established, an incision will be made in your abdomen and the colon and rectum will be removed. A J-shaped pouch will then be constructed from the ileum, which is the end of the small intestine. The J-shaped pouch will then be connected to the anus using sutures or staples. In some cases, a temporary ileostomy (bag) will be made to maximize the safety of the operation for you. However, our surgeons have been pioneers in performing restorative proctocolectomy without an ileostomy. You will have a dressing placed over the operative site.

Postoperative Care

Following a restorative proctocolectomy, you will be admitted to the hospital. You will receive pain medication and intravenous fluid. Once bowel function returns, as evidenced by passage of gas or stool, your diet will be advanced.

Once you tolerate a diet, and have no signs of fever or other complications of the surgery, you will be discharged from the hospital. You will be given a prescription for pain medication. In the 1-2 weeks following surgery, you will see your surgeon for a follow-up appointment.

Our Manhattan colorectal surgeons will help guide you through the entire procedure and the healing process.

Contact Us

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