The History of the J-Pouch
Ileal-pouch anal anastomosis has been one of the most effective treatments for ulcerative colitis (UC) since the 1980s. There are still many patients that have never even heard of the procedure or it’s early days of trial and error.
I've been researching the j-pouch since my procedure
In 2014, I had the procedure done myself. Since then, I’ve been doing a lot of research on the topic of J-Pouches and I feel like it would be insightful and even beneficial to share it with you so that you can get a better understanding of how far we’ve come when it comes to our treatment options.
Ileostomies were considered a good option for people with UC
Early on, ileostomies were considered a good option for people with ulcerative colitis, but it was a man by the name of Dr. Rudolf Nissen who is considered to be the first man to get the ball rolling for patients to have a continent option to the ostomy.
In 1933, he performed the operation on a 10-year-old with polyposis with great results. Then in 1947, a couple of doctors at Johns Hopkins Hospital experimented with the ileoanal anastomosis on 28 dogs. A few of these test subjects died of infection, but six of the dogs ended up helping to further the goal. Of the two doctors, Dr. Mark Ravitch was so confident in the procedure that he used the technique on two UC patients with great success.
The creation of the pouch
Several doctors continued to tweak and experiment with the surgery. One of the greatest problems was frequent bowel movements, dehydration, electrolyte imbalance, fistulas and abscesses. Drs. Bacon and Valiente sought to remedy these problems by creating a pouch or reservoir to substitute for the colon. Out of the seven animal subjects they attempted this technique on, only two survived which made the results disappointing.
The Kock Pouch
It wasn’t until 1969 that a Swedish surgeon, Dr. Nils Kock made the first continent intestinal reservoir that showed great promise. This pouch was called the Kock Pouch. It had what was called a “nipple valve” which allowed patients to empty their pouches by using a catheter. In the 70s it became the most widely used technique in the US. This pouch, however, was far from perfect and so the search for a better option continued.
S-pouch and j-pouch
In the 70’s and 80’s two different research groups working apart from each other produced great results. Dr. A. G. Parks created the first S-Pouch with temporary loop ileostomy and Dr. J. Utsunomiya experimented with different versions of the J-pouch with a temporary loop ileostomy. While both pouches became great options for patients, the J-Pouch produced more favorable outcomes.
In the 1980s, even more promise came for the ileal-pouch anal anastomosis with a better understanding of rectal anatomy and surgical staplers. These reduced leaks thereby reducing infections and so the search for the perfect pouch continued.
A better quality of life
In 1995, Dr. Victor Fazio at the Cleveland Clinic studied 1,005 patients. The patients with double-stapled J-Pouches showed greater promise than those of hand-sewn pouches. Despite the fact that there were still complications that came along with the surgery, 93% of patients reported a more favorable quality of life. This made the procedure a successful and safe option for patients.
The success of j-pouches
Today, the success rates of J-Pouches are higher than ever. As with any medical treatment, the more time goes on and as technology advances, better options and improvements are made to advance the patient outcome. I look forward to this procedure, as well as other, better options, being researched to help patients in the future.
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