Guide to Intestinal Pouches and Pouch Surgery
Reviewed by the physicians of Columbia’s Colorectal Surgery Team, March 2024
Sometimes treating colorectal conditions requires complete or near-complete removal of the colon and rectum. While doing so resolves the disease, it also clearly impacts the GI tract’s normal function of absorbing liquids and passing stool. In these cases, surgeons can often reconnect the remaining parts of the intestines to create an internal pouch that is joined to the anus and allows for stool to pass naturally, without the need for an external bag to collect waste.
Key Info
- Pouch procedures allow for people who have had their colon removed to avoid the need of an external waste-collecting bag
- There are different types of pouches. The most common are called the J-pouch and the K-pouch
- The most frequent complication of pouch procedures is infection of the pouch, known as pouchitis
Pouch surgery may be the optimal treatment for people with ulcerative colitis, Crohn's disease, familial adenomatous polyposis (FAP), select patients with Crohn's colitis, or other conditions involving the large intestine and or rectum.
Types of Pouches
J-pouch
The ‘J-pouch’ may be used to treat people with ulcerative colitis or familial polyposis who need to have their colon and most of the rectum surgically removed. If their anal sphincter is intact, a surgeon can use a part of the ileum (part of the small intestine) to create an internal pouch. The pouch is then connected to the anus just above the sphincter, which is preserved for continence. The connection creates a path in the shape of the letter J, which is why it’s called a J-pouch.
A J-pouch may also be called the following names:
- ileoanal reservoir
- ileoanal anastomosis
- pull-thru
- endorectal pull-through
- pelvic pouch
- ileal pouch anal anastomosis (IPAA)
K-pouch
The K-pouch is an option for people with poor anal sphincter function and those who have had their sphincters previously removed and have a traditional ostomy but wish to avoid the encumbrance of an external appliance.
K-pouch surgery entails connection of the end of the small intestine to the skin of the abdomen. Unlike other ileostomies, which drain continuously into an external appliance (bag), the K-pouch includes a special valve that prevents waste from leaking out. A catheter is inserted when it is time to empty the pouch. The K-pouch thus avoids the need for an external appliance for the collection of intestinal waste for people who do not wish or are not candidates for an ileoanal J pouch.
A K-pouch may also be referred to as:
- Koch pouch
- continent ileostomy
Stories & Perspectives
Pouch failure and pouch repair
Occasionally, a pouch will fail to work properly due to complications like leakage or inflammation. When pouch failure occurs, surgical options may include pouch revision, creation of a redo pouch, or neo-pouch creation. In some circumstances, the conversion of a J-pouch into a K-pouch may be considered to preserve continence and improve patients’ quality of life.
Pouchitis
Sometimes pouches become infected, leading to a complication known as pouchitis. Symptoms of pouchitis include diarrhea, pain, and fever. Pouchitis can usually be treated with antibiotic medications.
Next Steps
If you or someone you love is in need of care for a colorectal issue, we’re here to help. Our team is available for consultations, second opinions, and to perform any colorectal procedure, should one be necessary. Call us at (212) 342-1155 or request an appointment online. For IBD care, call (212) 305-9664.