Over the years, surveys of patients reveal that about 90% of people with a Barnett pouch (the BCIR is the Barnett modification of the Kock Pouch - the Barnett Continent Intestinal Reservoir) eat anything they want without limitations. Some food with roughage (mainly cellulose fiber in fruits and vegetables) does not break down very well, and it takes longer to evacuate because the drainage catheter gets plugged up and must be removed, cleaned, and re-inserted to finish emptying the pouch. Compared to a conventional Brooke ileostomy, nutrition is enhanced because nutrients are absorbed in-between intubations (self-catheterization), instead of the food material passing into the external pouch appliance where it can't be absorbed. The BCIR pouch is made from your intestine and continues to function like intestine should.
Recently I operated on a patient from Chicago who had other significant medical conditions. His surgery went well, as did the post-operative course, but he had significant difficulties emotionally that were quite legitimate, although unique to his unusual situation. After leaving the hospital and returning home, he wrote: "Thank you for all of your care. When I was at my worst, you were at your best."
What is ileostomy reversal? It is an operation to convert a conventional ileostomy to a Continent Ileostomy. This is an internal pouch made from your own intestine, together with a "nipple valve" also fashioned from your own intestine. There is a small stoma (ostomy) just above the pubic hair line, but no external pouch (appliance, collecting bag) is needed. That is because with a Continent Ileostomy no gas or stool comes out of the stoma until you insert a tube into the stoma down into the pouch, evacuating the waste into the toilet. This is usually done from 2-5 times daily, with most people sleeping through the night. For over 20 years I have been performing the BCIR or Barnett Continent Intestinal Reservoir, a major modification of the original Kock Pouch technique. The BCIR is suitable for people with a conventional ileostomy, a malfunctioning or failed ileoanal J-pouch, or with a malfunctioning Kock pouch.
Why do so few surgeons specialize in the Continent Ileostomy operation? The Kock Pouch and the Barnett version of the Kock Pouch (the BCIR for Barnett Continent Intestinal Reservoir) have been performed for over 40 years. It is because of the unique nature of the procedure, and the need to be committed as a Surgeon to the long-term care of the patient. If the patient with an internal pouch has a problem, they will need the help of their "Pouch Surgeon". If a patient with a pouch needs an unrelated operation later in life (hip replacement, prostate surgery, hysterectomy, etc, etc), their "pouch surgeon" will be contacted to advise concerning management issues. Fortunately, there are enough surgeons around the country and new surgeons learning the technique, that there will always be specialists to take care of you.
Anyone who has undergone removal of their entire colon (large intestine) and rectum and have a conventional Brooke ileostomy knows that life goes on. Fortunately, although it is not ideal to have to wear an external pouch continuously to collect digestive waste, most people are able to live a high quality life. This includes activities as diverse as sky diving and scuba diving. They will also make a good emotional adjustment concerning intimacy and sex. However, many ileostomates do not have such a satisfactory outcome. 11% will need a surgical revision during their lifetime. There may be leaks of the seal and allergic reactions to the adhesives. There are clothing limitations because of "bag bulge" from the external pouch filling with liquid or intestinal gas. For all of these people, there is another option -- the Continent Ileostomy. Since 1989 I have been performing the Barnett version of the Kock Pouch continent ileostomy. This is also referrred to as the BCIR or Barnett Continent Intestinal Reservoir. With this procedure there is no external pouch (bag, appliance). Instead, several times a day (average range 3-6) you painlessly insert a tube (catheter) into the stoma (flat and low on the abdominal wall) to evacuate the gas and waste. You only need a small covering over the stoma to absorb mucous.
Most doctors and nurses refer to the collecting device worn by people with a conventional Brooke ileostomy as "the external appliance" or "the bag". However, many people who have the ileostomy want the collecting device referred to as "the external pouch". In this time of trying to erase the stigma often associated with having an ileostomy, what do you think is appropriate? I think that if the people who live with this want to refer to it as the external pouch that they wear, we all ought to do the same.
I read this week that 50 million people in our country do not have health insurance currently. That is amazing and upsetting. I think of all the conditions that people must simply have to live with because they have no coverage for hospital care or doctor care. People who should have their hernia repaired or their sick gall bladder removed cannot get it done for the most part. That also means that people who have a malfunctioning conventional Brooke ileostomy or a failed ileoanal J pouch cannot get surgery to create a BCIR (Barnett Continent Intestinal Reservoir - the Barnett version of the Kock Pouch continent ileostomy). They know there is an option that will give them back control over the discharge of their intestinal waste but they can't have it done. We need other options for all of these people to become insured and get the care they deserve, including the "freedom option" for ileostomy patients.
The need to cure a disease or condition by removing the entire colon
(large intestine) and rectum requires creating a way to evacuate the
intestinal waste. The three options available include the conventional Brooke ileostomy, the ileoanal J-pouch, or the continent ileostomy.
Conventional Brooke ileostomy surgery
requires a permanent external appliance to collect the intestinal waste
because the small intestine is a continuous flow system. Material is
produced continuously, even when not eating. The end of the small
intestine is brought through an opening in the abdominal wall and sewn
to the skin to form a spout or nipple-like projection. This allows the
waste to flow into the appliance without contact with the skin. The
waste from the small intestine is corrosive to skin, so the appliance
must be cemented onto the skin and worn at all times. While most people
with a Brooke ileostomy lead a normal life, a
significant number will have episodes of leakage with skin irritation,
allergies to the adhesives, problems with "bag bulge", limitation in
activities, and difficulty making the emotional adjustment to life with
an appliance especially regarding intimate relations and dating. In
fact, 11% of people with a Brooke ileostomy will require a surgical revision during their lifetime. This may be for retraction of the stoma with inability to maintain a seal, prolapse (a stoma that becomes very long and rubs against the bag), or hernia.