What is a J-Pouch Takedown?

You learn a lot of new terminology and words when you’re diagnosed with an incurable illness and inflammatory bowel disease is certainly no exception. Endoscopy, barium, enema, tenesmus, immunosuppressants… the list goes on and on...The term I’d like to discuss today is the term “takedown”.

The most common use for this word is probably in the sport of wrestling. In wrestling, the takedown is a move in which the opponent is knocked to the floor quickly from a standing position. But in the world of IBD, this move is used to describe the final step in the ileal-pouch anal anastomosis (or j-pouch) surgery. Some people might even refer to this as a reversal, but that term is used for a completely different procedure.

How is a j-pouch for ulcerative colitis made?

When it comes to the j-pouch, construction can be done in several ways. Depending on the skill and experience of the surgeon, and the health of the patient this procedure can be done in one, two or even three surgeries. One of those surgeries is referred to as the “takedown.”

If the procedure is done in one stage, then the takedown is completely bypassed. But if the surgery is done in two or three stages, as mentioned before, the takedown is the final surgery in the j-pouch procedure.

My two-stage procedure for a j-pouch

For simplicity’s sake, I will describe the two-stage, full-open (non laparoscopic) procedure that my surgeon performed on me. In the first surgery, the surgeon will first slice you open beginning at the top of your navel and down to your pubic bone. Once he cuts through all the subcutaneous layers, the surgeon will cut your colon free of all the connective tissues holding it in place. He or she will then cut your terminal ileum (end of the small intestine) about 2cm away from your colon and then at the anal transition zone.

The anal transition zone is where your rectum becomes your anus. The surgeon leaves your anus intact and keeps your anal sphincters so that when everything is said and done you can go to the bathroom almost like a normal person again.

After your colon is free, the surgeon will remove it from your abdomen. He or she has just performed what is called a proctocolectomy.

The creation of a j-pouch

The surgeon will then fold the terminal ileum up and form a pouch in the shape of a “j.” Hence the term “j-pouch”. I won’t go into every detail of what happens next (difficult to explain without pictures), but after a few more cuts and staples, the surgeon will attach the j-pouch at the place where he cut your colon free from the anal transition zone.

After ensuring the j-pouch has no leaks, the surgeon will then make a smaller cut in your abdominal wall and pull your small intestine through it to create what is called a loop ileostomy which will divert stool outside of your body temporarily until your pouch matures and heals properly.

The takedown surgery for a j-pouch

I lived this way, with an ostomy (specifically an ileostomy) for three months. After three months I was put back under anesthesia and my surgeon closed up the loop ileostomy, poked my small intestine back into my abdomen and sutured up the skin. This is what is called the takedown surgery.

I hope everything made sense. Please know that I am not a doctor or medical professional at all. I would not even call myself a J-Pouch expert. I’m just some strange person with a morbid curiosity who studied her surgery notes and read several medical studies and journals about what a j-pouch is and how the surgery is performed.

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