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Alternative NamesRestorative 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
Definition Return to top
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.
Description Return to top
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:
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.
Why the Procedure is Performed Return to top
This procedure may be done for:
Risks Return to top
Risks for any surgery are:
Risks for this surgery include:
Before the Procedure Return to top
Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
Talk with your doctor or nurse about these things before you have surgery:
During the 2 weeks before your surgery:
The day before your surgery:
On the day of your surgery:
After the Procedure Return to top
You will be in the hospital for 3 to 7 days. By the second day, you will most likely be able to drink clear liquids. Your doctor or nurse will slowly add thicker fluids and then soft foods as your bowel begins to work again.
While you are in the hospital for the first stage of your surgery, your nurse and doctor will teach you how to care for your ileostomy.
Outlook (Prognosis) Return to top
Most people recovery fully. You will probably have 4 to 8 bowel movements a day after this surgery. You will need to adjust your lifestyle for this.
Most people who have a total abdominal colectomy recover fully. Most people are able to do most activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and most types of work.
References Return to top
Cima RR, Pemberton JH. Ileostomy, colostomy, and pouches. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2006:chap 110.
Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 50.
Khatri VP, Asensio JA, eds. Subtotal colectomy/panproctocolectomy and j-pouch reconstruction. Operative Surgery Manual. 1st Ed. Philadelphia, Pa: Saunders; 2003:chap 35.
Scriver G, Hyman N. Ileostomy construction. Operative Techniques in General Surgery. 2007;9(1): 43-49.Update Date: 1/26/2009 Updated 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.