In this operation, the surgeon will make an incision in the middle of your abdomen through which the diseased colon and upper rectum are removed. The lining of the lower rectum is removed to prevent disease recurrence. The anal sphincter muscles will remain in place to provide control of bowel movements.

The internal pouch, which is J shaped, is made from the end portion of the small intestine, called the ileum. (figure 1) The pouch is pulled down and sutured to what remains of the rectum. (figure 2) Eventually, this pouch will take the place of the removed rectum by storing stool between bowel movements.

In most cases, a temporary ilestomy is made to divert the stool so that the internal pouch can heal. A small portion of the ileum is brought out through the abdominal wall. (figure 3) The opening, or stoma, is usually on the right side of the abdomen. The stoma will protrude slightly-about 1/2 inch. If you are having a two-stage procedure, you will have the temporary ileostomy for about six to eight weeks.