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The Surgical Procedure

What can I expect during ileal J-pouch anal anastomosis surgery?
The large intestine (colon) and nearly the entire rectum are removed through an incision in your abdomen. In some cases, the surgeon then strips the inner lining of the remaining rectum.

An ileal J-pouch (which looks like the letter "J") is created. The J-pouch becomes a reservoir for waste and replaces the function of the rectum. The surgeon constructs the pouch from about 10 to 11 inches of ileum (small intestine) and attaches it to the anal muscle so that elimination remains relatively the same.

Since the entire small intestine is left intact, digestion remains essentially unchanged.

In many cases, a temporary "loop" ileostomy is created. This allows waste to be diverted into an external pouch, while the surgical area heals without the danger of irritation or infection from bacteria in stool. The loop construction of the stoma allows for a simpler reversal of the ostomy with less pain and a shorter recovery time.

If there is no tension between the pouch and the anal area, and if you are not taking drugs that delay healing (such as prednisone), the operation is sometimes performed in one step without a temporary loop ileostomy.

Remember: A temporary loop ileostomy is just that: temporary. If you have a temporary loop ileostomy, it's important to protect the skin around the ostomy. Be sure to see "Going Home: Part III" for how to care for your temporary ileostomy.

How long will the operation take?
Generally, the amount of time required to perform the surgery can be as short as three hours or as long as six hours. This depends on your condition and the complexity of the surgery.

How quickly can I expect to recover from surgery?
The speed of your recovery depends on many factors, including your disease state, your age, and your overall health.

Remember: Everyone recovers at his or her own pace. Try not to compare yourself to others in similar situations because what may apply to one person may not apply to you.

To learn more about what you may experience post-operatively, check out "After Surgery: Recovery in the Hospital."

Will there be a follow-up surgery?
If you have a temporary ileostomy, you will have a second surgery about eight weeks later to reverse it. This second surgery is a much shorter operation with a more rapid recovery time. This is because the incision for the closure of the ileostomy, which is just around the stoma, is smaller—about two inches wide.

In some cases; however, your surgeon may have to reopen the first incision to clear out some scar tissue. It is common for scar tissue to form in the bowel as part of the healing process. Removing the scar tissue will help ensure that the intestine is able to function properly.

You'll find helpful information about preparation and recovery in "The Second Surgery."

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