Since its introduction in the 1970s, the J-Pouch has become the standard surgical intervention for chronic ulcerative colitis and for most patients with familial adenomatous polyposis. Even though it’s a standard course of action, doesn’t mean the procedure is without serious risk.
J-Pouch surgery itself doesn’t usually pose a risk to patients’ lives, but the morbidity rate is extremely high. That means post-surgical complications are very likely to occur, which can pose significant risks to patients’ health. Read on to learn how a failed J-pouch can impact a patient’s well-being.
The most serious early complication following surgery, pelvic sepsis, is one of the main causes of J-Pouch failure. Sepsis usually occurs three to six days following surgery at a rate of 5 to 24 percent. Leaks along suture lines or bacterial contamination during the surgical procedure are likely causes. Fever, abdominal pain, pus-like discharge and an increase in white blood cells are common symptoms. A higher rate of complications may occur in patient without a previous ileostomy.
Researchers estimate that between 5 and 18 percent of patients with a J-pouch will experience leakage. Leaks can occur in three areas: the pouch itself, the tip of the J-pouch or from the area where the pouch connects to the anus. Elderly patients, men, and patients who take corticosteroids are more likely to develop leaks. Some leaks will heal on their own; others require additional surgeries, bowel rest and limited diets, the insertion of a trans-anal catheter for daily irrigation or other interventions.
Patients who undergo J-pouch surgery are at increased risk of small bowel obstruction. The problem occurs in 15 to 44 percent of patients. Of those, 5 to 20 percent require surgical interventions, and the risk continues to increase the longer a patient has a J-pouch. One study found the risk of small bowel obstruction is 9 percent at 30 days post surgery, 18 percent one year later, 27 percent at five years and 31 percent at 10 years.
The most common complication of a J-Pouch, pouchitis is an acute or chronic inflammation of the ileal reservoir. Symptoms can include increased stool frequency, urgency, abdominal pain, bright red bleeding, fecal incontinence, diarrhea, and fever. In some cases, the condition may cause arthritis, iritis, and pyoderma gangrenosum elsewhere in the body. Research indicates that as many as 50 percent of J-Pouch patients experience pouchitis with the rate of incidences increasing as time goes on.
Several months after surgery, patients may experience a vaginal, perineal, cutaneous or presacral fistula. In other words, a fistula is an abnormal connection between organs or tissues. While some fistulae are treated with antibiotics and able to heal on their own, many require additional invasive surgeries.
A failed J-pouch can force a patient to undergo a variety of invasive procedure and surgeries. While many surgeons opt for this type of continence surgery following the removal of the colon, it can risk patients’ health and create significant inconveniences.