Ileo-anal pouch formation (restorative proctocolectomy)

The ileum is the name given to the lower part of the small intestine which runs down in loops to meet the large intestine (colon). These loops of bowel exist to allow the diffusion of water and nutrients from the food we eat to pass in to the bloodstream to be used.

Unfortunately, some individuals suffer from inflammatory bowel disease which when unable to manage with medication may necessitate surgery. Ileo-anal pouch formation surgery is primarily done to relieve the symptoms of certain types of inflammatory bowel disease and in some cases to treat cancer of the colon.

The surgery is offered by Circle's expert general and colorectal consultant surgeons.

This operation is normally planned in two stages.

The first stage is to remove the colon and replumb the upper portion of the small intestine into a hole formed in the upper abdomen known as an ileostomy. A pouch is created in the lower portion of the small intestine and plumbed in to the anal canal. This approach allows waste to pass into a colostomy bag for several weeks while the created pouch is allowed to heal.

The second part of an ileo-anal pouch formation surgery reverses the ileostomy and reroutes the two ends of the small intestine together to allow waste removal from the anal canal once more.

The first and second stages of the operation will require a pre-operative assessment in which our specialist anaesthetic team will ensure you are medically well to undergo the surgery. To ensure you are as relaxed as possible for your surgery, it is normal to come into hospital the day prior to your operation(s).

Possible postoperative risks associated with ileo-anal pouch formation surgery can include:

  • General anaesthetic risks (commonly nausea and fatigue)
  • Wound infection (very rare due to laparoscopic technique)
  • Sepsis due to infection
  • Leaks from the newly formed pouch
  • Bleeding into the pouch

Longer term complications from this type of surgery which may necessitate further surgery include

  • Failure of the pouch
  • Holes forming in the pouch (known as a fistula)
  • Inflammation of the pouch (known as pouchitis)

Immediately following surgery our general surgery specialists and nursing staff will monitor you for any signs of complications. To effectively monitor for any signs of complications, you will be required to stay in hospital for up to one week after the surgery.

To maximise nutrient uptake and reduce the chances of irritation to the newly formed pouch, it is recommended to begin a low fibre and high protein diet initially. Furthermore, after this operation, the ability of the body to absorb water and salts is reduced. As such, it may be necessary to increase fluid intake and/ or drink electrolyte mix drinks in more persistent cases of dehydration.

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Circle Health Group, 1st Floor, 30 Cannon Street, London, EC4M 6XH