What is an Ileoanal Anastomosis?

Mary McMahon

An ileoanal anastomosis is a type of gastrointestinal surgery where the entire large intestine is removed and the base of the small intestine is connected with the anal canal. This procedure is very invasive and is typically performed after more conservative approaches to treatment have failed, most commonly in cases of severe ulcerative colitis. Recovery times vary, depending on the patient's level of health at the time of the procedure. Critically, the surgery allows patients to retain bowel control, rather than having to use an ileostomy bag.

The entire large intestine is removed during an ileonal anastomosis.
The entire large intestine is removed during an ileonal anastomosis.

Inflammation and disease of the large intestine is treated in a variety of ways with the goal of helping patients retain full bowel function. If these treatments do not work, an ileoanal anastomosis may be recommended. In the procedure, the surgeon cuts the large intestine out entirely, removing the diseased tissue. The ileum, the structure at the base of the small intestine, is attached directly to the anal canal. If the patient is in reasonably good condition, a pouch will be made at the same time to hold a reservoir for stool. If the patient is unwell, a second procedure may be needed to make the pouch.

Also known as a J-pouch or S-pouch procedure, this surgery is commonly performed on men, usually over the age of 35. After the surgery, the patient will need to follow special dietary recommendations while the bowel recovers and to maintain bowel health after healing from surgery. People with an ileoanal anastomosis can be at increased risk of dehydration and some other health problems and it is important to monitor their health carefully.

Surgery carries a number of risks and invasive abdominal procedures can be dangerous. There are risks of having adverse reactions to anesthesia during the procedure, and it is also possible to develop inflammation and infections in the bowel. If the anastomosis is not conducted properly, it may rupture, introducing stool to the abdominal cavity, and this could pose serious risks for the patient. Using a highly qualified surgeon will help reduce risks, as will working with an experienced anesthesiologist.

Before receiving an ileoanal anastomosis, patients may want to ask about aftercare instructions, so they know what to expect and how to prepare for surgical recovery. During recovery, patients should be alert to abdominal pain, tenderness, swelling, and heat, as these can all be signs of surgical complications. Patients may be monitored for several days in hospital before being released home to identify any immediate problems with an ileoanal anastomosis in a timely fashion.

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