S-pouch

S-pouch is a type of ileal pouch-anal anastomosis (IPAA), which is a surgical procedure performed to create a reservoir for stool in patients who have had their colon and rectum removed. The S-pouch is named for its shape, which resembles the letter "S". This procedure is often utilized in the treatment of Ulcerative Colitis, Familial Adenomatous Polyposis (FAP), and other conditions that necessitate the removal of the colon and rectum.

Overview

The S-pouch serves as a storage area for feces, allowing for voluntary bowel movements and preserving the anal sphincter, thus maintaining continence. The construction of an S-pouch involves using a portion of the small intestine to form a new reservoir for stool. This surgical technique is considered when the entire colon and rectum need to be removed but the anal sphincter muscles are intact and functional.

Surgical Procedure

The procedure to create an S-pouch typically involves three stages. First, the diseased colon and rectum are removed. Next, a section of the small intestine, usually the ileum, is used to create the pouch. The S-pouch is fashioned by folding a length of the ileum back on itself twice, creating three limbs that form an "S" shape. The bottom of the "S" is then connected to the anus, allowing stool to be stored in the pouch and passed in a controlled manner.

Advantages and Disadvantages

One of the main advantages of the S-pouch is its capacity, which is typically larger than that of other types of pouches, such as the J-pouch. This can result in fewer bowel movements per day. However, the S-pouch is more complex to construct and may have a higher risk of complications, such as pouchitis (inflammation of the pouch), compared to other pouch designs.

Postoperative Care

After surgery, patients may require a temporary ileostomy, which is a surgical opening made in the abdomen for waste to exit the body into a bag, allowing the newly formed pouch to heal. The ileostomy is usually reversed in a subsequent surgery, after which the S-pouch begins to function.

Living with an S-pouch

Patients with an S-pouch will need to adapt to a new bowel routine. This may include dietary changes to manage stool consistency and volume, as well as regular follow-up care with a healthcare provider to monitor the health of the pouch and address any complications.

Conclusion

The S-pouch is a significant surgical advancement for patients requiring removal of the colon and rectum, offering an alternative that preserves anal continence. While it presents certain challenges and risks, for many patients, it provides a satisfactory quality of life post-surgery.