All you need to know about J-pouch surgery

Patients suffering from serious bowel diseases may be offered J-pouch surgery as an alternative to living with a stoma following a removal of the colon and rectum. In this informative article, leading consultant colorectal surgeon Mr Talvinder Gill, who is specialist in laparoscopic (minimally invasive) procedures, gives a detailed guide to J-pouch surgery. Mr Gill also reveals how the use of a single incision technique in his practice is improving patient safety and outcomes.

What is J-pouch surgery?

In ileal pouch surgery, a pouch is created from part of the small bowel which is connected to the anal canal. This is done in cases where the colon and rectum have been removed as the newly created pouch allows an increased storage of faeces. Different varieties of pouch have been created in the past, described according to their shape, such as the S or W pouch. The J shaped pouch is the most commonly used nowadays.

Who is a suitable candidate for J-pouch surgery?

Any patient who has had their colon and rectum removed for any reason can be considered for ileal or J-pouch surgery. Most commonly, patients suffering from ulcerative colitis or polyposis syndrome undergo J-pouch surgery. Patients with other types of colitis are also suitable for J pouch surgery but it is not usually recommended for Crohn’s disease. Some patients with more than one colorectal cancer may also be considered for this procedure.

How does J-pouch surgery compare to permanent ileostomy?

J-pouch surgery is an alternative approach to restoring bowel function. The main advantage of J-pouch surgery is that the patient is free of a stoma following the procedure. Permanent ileostomy, on the other hand, is a major operation with some associated risks and complications where an opening is created on the abdomen to allow waste to be collected.

Is J-pouch surgery major surgery?

There are many different ways to perform J-pouch surgery, including open surgery, total or assisted laparoscopic surgery and robotic assisted surgery. In my practice, I perform this procedure as a single incision laparoscopic surgery, which means the whole operation is performed through just one incision which is 3 centimetres in length. If a patient is having a stoma, the procedure is done through the stoma site itself without any other incisions making it a scar-free procedure.

There are very few surgeons in the world who regularly perform this as single incision laparoscopic surgery. I have been performing the procedure in this way since 2010 and along with my team, we provide regular training courses for other surgeons at University Hospital of North Tees.

How long does J-pouch surgery last?

Ileal pouch surgery works well in most patients but unfortunately there is a failure of around ten per cent over ten years. These patients go back to ileostomy due to poor functioning of the pouch. The failure rate mostly depends on the condition of the patient that prompted the surgery. For instance, failure of ileal pouch surgery is more common in indeterminate colitis patients in comparison to ulcerative colitis patients. Pouch surgery for non-inflammatory conditions such as polyposis syndrome have a very high success rate and failure is very uncommon.

Is a J-pouch permanent?

Ileal pouch would be considered permanent in eighty to one hundred per cent of cases depending on the patient’s condition which prompted a removal of the colon and rectum.

If you are considering undergoing a J-pouch procedure and wish to book a consultation with Mr Gill, don’t hesitate to visit his Top Doctors profile.