Pouch surgery

pouch surgery

Pouch surgery a surgically constructed internal reservoir; usually situated near where the would normally be. It is formed by folding loops of small intestine back on themselves and stitching or stapling them together. The internal walls are then removed thus forming a reservoir. The reservoir is then stitched or stapled into the perineum where the rectum was. The procedure retains or restores functionality of the anus with stools passed under voluntary control of the patient.

Symptoms:

Symptoms of pouchitis include the following:

  • greater need to pass stools
  • tenesmus (painful spasms and straining of the anal sphincter while passing little or no waste matter)
  • straining during defecation
  • blood in the stool
  • incontinence (loss of control over bodily functions)
  • seepage of waste matter while asleep
  • increased frequency in nighttime bowel movements
  • abdominal cramps
  • discomfort in the pelvic area or lower abdomen
  • tail bone pain

Diagnosis:

The doctor will consider the patient’s symptoms and the results of an endoscopy (examination of the inside of the pouch with an instrument called an endoscope). Endoscopy of the pouch can show how widespread the inflammation is, whether or not the ileum is irritated, or if the patient has Crohn’s disease or Crohn’s-like disease of the pouch.

Endoscopy can also show if the patient has cuffitis (inflammation at the anal transition zone or cuff), or abnormalities such as narrowed passages or cavities or openings. Patients who have cuffitis often have bright red blood (mild to moderate, or on wiping) in stool.

Treatments:

In this surgical procedure the ileum is attached to the anus after the rectum has been removed.

  • In a J-pouch anastomosis, a 12-inch section of the small intestine is formed into a J-shaped pouch in order to replace the function of the rectum and store stool until it can be eliminated. This procedure is similar to the side-to-end coloanal anastomosis but a larger pouch is formed.
  • In a Side-to-end coloanal anastomosisa side of the colon is attached to the anus after the rectum has been removed. A section of the colon about 2 inches long is formed into a mini-pouch in order to replace the function of the rectum and store stool until it can be eliminated. This procedure is similar to the J-pouch coloanal anastomosis but a much smaller pouch is formed.

The entire procedure can be performed in one operation, but is usually split into two or three. When done as a two-step, the first operation involves a proctocolectomy, and fashioning of the pouch. The patient is given a temporary defunctioning ileostomy. After a period of usually 6–12 weeks the second step is performed, in which the ileostomy is reversed. The reason for the temporary ileostomy is to allow the newly constructed pouch to fully heal without waste passing through it, thus avoiding infection.