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The Surgical Procedure

What can I expect during colorectal or coloanal anastomosis surgery?
Depending on your disease, either the upper part of the rectum (colorectal anastomosis) or the entire rectum is removed through an incision in your abdomen. If the entire rectum is removed, the surgeon connects the colon to the anus (coloanal anastomosis).

Generally, if more than half of the rectum is removed, a colon pouch ("J-pouch") is created. The J-pouch becomes a reservoir for waste and replaces the function of the rectum that was removed. The surgeon constructs the pouch from about 2-4 inches of colon (large intestine) and attaches it to the remaining rectum or to the anal muscle if the entire rectum has been removed.

Image of colon pouch with coloanal anastomosis

Colon Pouch with Coloanal Anastomosis
Copyright © 2003 by Susan Galandiuk, MD, Louisville, KY.

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.

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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.

What is the difference between colorectal and coloanal anastomosis surgery?
A brief comparison of each operation is outlined below.

Colorectal Anastomosis   Coloanal Anastomosis
Disease limited to the upper half of the rectum

Only the diseased portion of the rectum is removed. The colon (large intestine) is connected to the remaining rectum.

Temporary loop ileostomy only occasionally necessary if the area of bowel connection is low, if there has been an infection, or if you had radiation to the surgical area because of rectal cancer.
  Extensive disease or disease involvement of the lower rectum

The entire rectum is removed-leaving the anal muscle intact. The colon (large intestine) is connected directly to the anal muscle.

Temporary loop ileostomy is usually created because the connection is extremely low-and the colon is actually sewn to the anal muscle.

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, the number of previous operations, 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.

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 Colorectal or Coloanal Anastomosis 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. You may be relieved to know that the 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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