Can J pouch surgery be done laparoscopically?

Yes it can be done but some factors may prevent that. I had a bowel resection back in 2013 that was done Laparo. When it came time to do my J Pouch surgery, when my surgeon tried to do it Laparo, there was so much scar tissue from my first surgery that he could not get the instruments in. They had to do open and it took more than an hour to cut through my scar tissue.

Some are done as partial laparoscopic (assisted); my surgeon does a bikini line incision during step-2 (j-pouch creation). It's a small incision of just a few inches horizontally

My skin failed due to prednisone when they tried to do my colectomy (step-1) laparoscopically so I have about a 10" vertical scar near my belly button because they had to do it as an open surgery. My surgeon for step-2 went right next to it for his incision and stapled me up plus the bikini line incision.

I am sorry, that sounds scary, but I am happy you're okay. I would do the same thing you're doing, try to find someone who can at least minimize the incisions. Look for colorectal surgeons and meet a few & see what the options are.

Messthezombie:'
Your desire for a laparoscopic approach in creating a J pouch may be limited by your prior perforation, peritonitis (due to escaped fecal matter into the ordinarily prestine abdominal/pelvic cavity), and subsequent adhesions.

The problem with adhesions/scar tissue is that it makes for what surgeons call a "hostile abdomen." Adhesions are the most common denominator that necessitates an open incision after an prior abdominal surgery. Laparoscopic surgery requires that the abdomen be inflated like a ballon with carbon dioxide. This gives the surgeon a free operating field and direct visualization. Inflating an abdomen that is littered with adhesions is a contra-indication to laparoscopic approach. Adhesions tether connective tissue, organs, and the intestines to each other like a spider's web. An attempt to inflate an abdomen with adhesions can result in massive ripping and dislocation of tissue and blood vessels. Most surgeons will tred very cautiously in offering a laparoscopic approach to someone with a prior open incision.

Know, too, that peritonitis adds to the density of scar tissue and adhesions due to the heightened inflammatory response to the bacterial intrusion. Your perforation with leakage of bowel content will place you at higher likelyhood of significant adhesion formation than someone without a perforation.

Note that I, too, had a severe intestinal perforation with peritonitis and sepsis. So I speak from a reference of similar circumstances to your own.

Do not judge your surgeon's competence on whether or not he/she is willing to offer your una laproscopic approach. Any surgeon who would blindly offer you a laparoscopic approach is not a surgeon that I would trust. Your abdomen may well be a "hostile abdomen" and an open incision may be the far safer approach to understake.

I have had 4 open abdominal surgeries related to my initial perforation and later abscess and small bowel obstruction. The SBO was due to adhesions. My lengthy scar Line has healed nicely. I wore a compression tube wrap and long compression camisole - the compression helped minimize an elevated scar. I also employed tissue massage to keep the scar subtle. An ugly scar Line need not be inevitable.

Bottom Line: if your abdomen is rich with adhesions due to your prior perforation and peritonitis, an open incision will be the safer route to employ in constructing your j pouch.
- Laren -