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Ileo-Pouch Anal Anastomosis Guide
During the surgery, your entire colon and rectum is removed, but your anus is preserved. If possible, a very short segment of the lowest part of the rectum may be preserved to facilitate putting the bowel back together.
Usually, you will begin your bowel preparation one day prior to surgery. We have learned that cleansing the bowel helps reduce the risks of infection and surgical complications.
The bowel preparation generally involves two parts. The first is a brief restriction of the diet to liquids, while at the same time taking some form of oral laxative. There is a large selection of laxative solutions, such as "Go Lightly" or "New Lightly," that will wash the bowel and colon clean of all debris. Smaller volume laxatives such as "Phosphosoda" or "Magnesium Citrate" will cause increased colon activity, and similarly clean the colon. Patients will have their individual preferences, and we are happy to work with you to identify the preparation that is most tolerable to you.
The second stage of the bowel preparation uses antibiotics to help minimize the risk of infection. These include antibiotics that are not absorbed and help decrease the bacterial count in the colon, and those that are absorbed by virtue of being present in the tissue at the time of surgery. These bowel preparations have been developed carefully over the last 30 years. Although some patients find them to be unpleasant, they are worth the time and effort to prepare the bowel for surgery.
In addition to the bowel preparation, you will also be instructed in the use of an incentive spirometer. This is a device that helps to keep the lungs inflated and minimize the risks of pneumonia after surgery. You should make every effort to practice with this so that you will be effective with it following surgery.
Prior to surgery, you will visit with an enterostomal therapist (ET nurse). The ET nurse will discuss the management of your ileostomy with you, give you materials to help you understand the role of an ileostomy, and mark the best location for the placement of the ileostomy. Although this operation can be done with or without a temporary diverting ileostomy, all patients are marked for an ileostomy in the event that one is necessary.
The location of the ileostomy mark will be selected based on several criteria that are specific to you. First, the location is limited to an area approximately halfway between your right hip and your navel. Second, it must be on the muscle running up and down the abdomen. Third, the ET nurse will discuss with you any personal or physical needs you may have, such as wheelchairs, work requirements or other physical limitations. The ileostomy should not be located where you wear a belt or in a crease or fold of the skin where it would make appliance placement difficult.
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