- After total proctocolectomy, the terminal ileum is prepared for pouch construction
- Adequate length of small bowel is ensured by mobilizing the mesentery without compromising vascular supply
- Typically 15–20 cm of ileum is used to construct a J-pouch
- Pouch formation
- The terminal ileum is folded back on itself in a J configuration
- An enterotomy is made in the apex of the J
- A linear stapler is introduced along the length of the limbs with multiple firings often required to complete the pouch creation
- Anastomosis
- The anvil of a circular stapler is then secured in the previously made enterotomy at the apex of the J pouch
- The pouch is brought down into the pelvis
- Ensure no twist in the mesentery and that the pouch reaches the anal canal without tension
- Further mesenteric lengthening manoeuvres may be needed
- Staple gun introduced per rectum and fired
- A diverting loop ileostomy is commonly formed