Total proctocolectomy and ileal-anal pouch

You will receive general anesthesia before your surgery. You will be asleep and unable to feel pain.

You may have the procedure in one or two stages:

• Your surgeon will make a surgical cut in your belly. Then your surgeon will remove your large intestine.
• Next, your surgeon will remove your rectum. Your anus and anal sphincter will be left in place. The anal sphincter is the muscle that opens your anus when you have a bowel movement and then closes afterwards so you do not leak stool.
• Then your surgeon will make a pouch out of the last 12 inches (30 centimeters) of your small intestine. The pouch is attached to your anus inside your abdomen.
• Your incision in the abdomen will be closed, or in some cases your skin may be left open.

Some surgeons perform this operation using a camera that is part of an instrument called a laparoscope. This surgery is called laparoscopy. It is done with a few small surgical cuts. Sometimes a larger cut is made so the surgeon can also work by hand. The advantages of this surgery are a faster recovery, less pain, and only a few small cuts.

If you have an ileostomy, your surgeon will close it during the last stage of the surgery.

This procedure may be done for:

• Ulcerative colitis
• Familial polyposis

Risks of anesthesia and surgery in general are:

• Reactions to medicines
• Breathing problems
• Bleeding, blood clots
• Infection

Risks of having this surgery include:

• Bulging tissue through the cut, called an incisional hernia.
• Damage to nearby organs in the body and nerves in the pelvis.
• Scar tissue that forms in the belly and causes a blockage of the small intestine (this scar tissue is often called adhesions).
• The place where the small intestine is attached to the anus (anastomosis) may come open, causing infection or abscess.
• Wound breaking open.
• Wound infection.
• Infection of the pouch (pouchitis), which can cause diarrhea, abdominal pain, fever, and dehydration.
• Narrowing of the area between the pouch and the anus (stricture).
• Sexual dysfunction due to nerve damage to the surrounding area.
• Iron deficiency due to poor diet, malabsorption, and intermittent blood loss.
• Frequent diarrhea and stool incontinence.

Before you have surgery, talk with your surgeon about the following things:

• Intimacy and sexuality
• Pregnancy
• Sports
• Work

Tell your surgeon or nurse if:

• You are or could be pregnant
• You are taking any medicines, including medicine, supplements, or herbs you bought without a prescription
• You have been drinking a lot of alcohol, more than 1 or 2 drinks a day

Planning for your surgery:

• If you have diabetes, heart disease, or other medical conditions, your surgeon may ask you to see the provider who treats you for these conditions.
• If you smoke, it's important to cut back or quit. Smoking can slow healing and increase the risk for blood clots. Ask your provider for help quitting smoking.
• If needed, prepare your home to make it easier to recover after surgery.
• Ask your surgeon if you need to arrange to have someone drive you home after your surgery.

During the week before your surgery:

• You may be asked to temporarily stop taking medicines that keep your blood from clotting. These medicines are called blood thinners. This includes over-the-counter medicines and supplements such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and vitamin E. Many prescription medicines are also blood thinners.
• Ask your surgeon which medicines you should still take on the day of surgery.
• Let your surgeon know about any illness you may have before your surgery. This includes COVID-19, a cold, flu, fever, herpes outbreak, or other illness. If you do get sick, your surgery may need to be postponed.

The day before your surgery:

• You may be asked to drink only clear liquids, such as broth, clear juice, and water after a certain time.
• Follow the instructions you have been given about when to stop eating and drinking.
• You may need to use enemas or laxatives to clear out your intestines. Your surgeon will give you instructions on how to use them.

On the day of your surgery:

• Follow instructions about when to stop eating and drinking.
• Take the medicines your surgeon told you to take with a small sip of water.
• Follow instructions on when to arrive at the hospital. Be sure to arrive on time.

You will be in the hospital for 3 to 7 days in most cases. By the second day, you will most likely be able to drink clear liquids. You will be able to add thicker fluids and then soft foods to your diet as your bowel begins to work again.

You will probably have 4 to 8 bowel movements a day after this surgery. You will need to adjust your lifestyle for this.

Most people recover fully. They can do most activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and most types of work.

Restorative proctocolectomy; Ileal-anal resection; Ileal-anal pouch; J-pouch; S-pouch; Pelvic pouch; Ileal-anal pouch; Ileal pouch-anal anastomosis; IPAA; Ileal-anal reservoir surgery

Horesh N, Emile S, Wexner SD. Colon and rectum. In: Tyler DS, Hayes-Dixon A, Hines OJ, et al, eds. Sabiston Textbook of Surgery. 22nd ed. Philadelphia, PA: Elsevier; 2026:chap 95.

Olortegui KS, Hyman N. Ileostomies, colostomies, and anastomoses. In: Chung RT, Rubin DT, Wilcox CM, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 12th ed. Philadelphia, PA: Elsevier; 2026:chap 119.

Updated by: Ann M. Rogers, MD, FACS, Professor Emeritus, Department of Surgery, Penn State College of Medicine, Hershey, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.