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Really basic question about j-pouch

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Posted 7/21/2013 5:53 PM (GMT 0)
I really should know this by now, but I've been absorbing so much info over the past few weeks (had total colectomy/ileostomy on June 24), some of it gets jumbled.

My ileostomy is temporary and the doctor plans to reattach the small intestine to my anus (or rectum?) in a few months. Is this a j-pouch? Or is that something different? From what I know, I'm having only two surgeries in total for this, so I guess it's a two-step.
Posted 7/21/2013 6:56 PM (GMT 0)
Do you still have a rectum left behind, or was it removed and also a jpouch created in your first surgery? Some crohnies get their small gut connected durectly to their rectum- the IRA procedure as opposed to IAA jpouch procedure. Sounds like this is what you are getting? Virtually unheard of for UC but not that uncommon in crohns. Best wishes.. pro
Posted 7/21/2013 7:50 PM (GMT 0)
With a j pouch, your rectum is removed. The j pouch takes the place of the rectum. Do you have UC or Crohn's? With UC the rectum goes and you get a j pouch. Other procedures for CD the small intestine can be attached right to the rectum so I'm not sure what you are having done.
Posted 7/21/2013 8:14 PM (GMT 0)
I have Crohn's, and they left my rectum in place. The small intestine will be attached to the rectum. I just wasn't sure if that was a j-pouch, for some reason.

Anyway, thanks to you both for the quick replies. It seems like most people here have j-pouches. I wonder how many people in this forum have what I'm getting.
Posted 7/21/2013 9:44 PM (GMT 0)
Sounds like you are getting ileorectal anastomosis, known as IRA for short. It's a less common procedure but can be a good choice for rectal sparing Crohn's colitis (Crohn's that affects the colon but not the rectum or small intestine). In many ways it is better than a j-pouch because your rectum has been working as a rectum already for your entire life, while a j-pouch is a totally new "organ" that needs to "learn" how to store waste and function "like" a rectum.

This article is a good fairly recent summary describing outcomes for IRA with Crohn's colitis: www.ncbi.nlm.nih.gov/pubmed/21979177
Posted 7/21/2013 9:50 PM (GMT 0)
The procedure you will be getting is called an ileo-rectal anastomosis, whereby the ileum is attached to the remaining rectum. The medical term for a j-pouch is ileo-anal anastomosis, whereby the ileum is joined to the anus. In order to do this, a pouch is formed at the end of the ileum, by making a length ways incision and doubling part of the ileum back on itself, hence the term j-pouch. The pouch takes the place of the removed rectum. Colectomies seem to be more common for "UCers", and we can't usually have an ileo-rectal anastomosis, as the rectum is almost always diseased. Hence j-pouchers are more prevalent on this board.
Posted 7/21/2013 9:52 PM (GMT 0)
Pluot must have posted while I was typing that last response!
Posted 7/21/2013 11:33 PM (GMT 0)
Thanks, Liz and Silent Lucidity. That really clarifies things. I'm finally starting to understand all this. It's a lot to take in, especially since I'm also having to learn about being on TPN, having PSC and being on the liver transplant list, and now that I've developed ascites, I've been researching that as well. Talk about a full-time job! (Not looking forward to returning to work.)
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