When medication fails to control a patient's ulcerative colitis symptoms, the most common surgical procedure recommended is a proctocolectomy with ileal pouch-anal anastomosis, also known as j-pouch surgery. During this procedure, a j-pouch, also known as an ileal pouch anal-anastomosis, is constructed. Your colon and rectum will be removed, and the surgeon will create an internal pouch—typically shaped like a J—using the ileum, the terminal portion of your small intestine. Although it can be done in three stages, this surgery is typically done in two. Your colon and rectum are removed during the initial procedure, but your anus and anal sphincter muscles are left intact. The top of your anal canal is joined to the ileum, which is made into a j-shaped pouch. Usually, a temporary ileostomy is made to allow your newly formed pouch to heal. A stoma, or abdominal opening, will be used to pull a loop of your small intestine through so that waste can be transferred from your body into an ostomy bag. You will have to empty your ostomy bag multiple times a day and wear it at all times during this period.

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