Carefully! Using 4-5 small incisions we free up all the attachments of the colon and rectum. Then we divide the rectum above the anal muscles or sphincters and make an extraction incision. About 3 inches in size. After removal of the colon and rectum we create the pouch and then attach it to the anal muscles. Sometimes you need a bikini incision to help with the pelvic part of the surgery.
Very carefully... A j-pouch is constructed from your own small intestine. The intestine is doubled over on itself for a few inches into a "j" where the bottom part of the j is fashioned into a common channel, or a pouch, using a surgical stapler. The purpose is to create a pouch where stool can be stored so that the patient doesn't have to run to the rest room all the time.