Health experts estimate that more than two million Americans suffer from severe bowel disease, including ulcerative colitis, familial polyposis and multiple colon tumors. These conditions may require the removal of the entire colon. Until the late 1960s, those suffering from these medically unresponsive intestinal diseases had only one surgical choice - a Brooke ileostomy.
Dr. William Barnett (left) talks with Dr. Nils Kock (right) at the 1985 UOA Convention
Dr. Nils Kock, of Sweden, developed the first intra-abdominal continent ileostomy in the late 1960s. By the early 1970s, several major medical centers in the United States were performing Kock pouch ileostomies on patients with ulcerative colitis and familial polyposis.*
One problem that plagued these early Kock pouches was valve slippage. This often resulted in difficulty intubating and an incontinent pouch. As a result, many of these pouches had to be revised or removed to allow a better quality of life.
Dr. William Barnett
The late Dr. William O. Barnett began making modifications to the Kock pouch in 1979. He had tremendous faith in the concept of the continent reservoir, but was disappointed with the relatively high failure rate regarding the valve. Dr. Barnett was intent on achieving a satisfactory solution to the problem.
The first change that he instituted was in the method of construction of the nipple valve. He changed the direction of flow within this segment of intestine, in order to keep the valve in place. This resulted in a much better success rate. In addition, a plastic material called Marlex was utilized to form a collar around the valve. This was designed to further stabilize and support the valve and resulted in less valve slippage. This technique worked very well, but after several years, the intestine reacted to the Marlex with the formation of fistulae (abnormal connections) into the valve.
Dr. Barnett continued his investigation in an effort to improve these results. After much effort, the idea came to him - a 'living collar' constructed from the small intestine. This technique not only enhanced the stabilization of the valve, it eliminated the problems associated with the Marlex collar.
Dr. James Pollack
After a series of over 300 patients, Dr. Barnett relocated to St. Petersburg, Florida where he joined the staff of Palms of Pasadena Hospital. Dr. Barnett's goal was to train other surgeons to perform the Continent Intestinal Reservoir. With the assistance of Dr. James Pollack, the first BCIR (Barnett Continent Intestinal Reservoir) program was established. Together, both surgeons made further enhancements to the procedure to bring it to where it is today. These modifications included changing the configuration of the pouch so that the number of suture lines was decreased from three to one, allowing the pouch to heal faster and reducing the chance of developing fistulae, and the creation of a serosal patch over the suture lines to prevent leakage.
The end result of these efforts has been a Continent Intestinal Reservoir with minimal complications and satisfactory function. As you go to other areas on this Web site, you will find more information that explains how a BCIR works, frequently asked questions with answers and clinical data that reflects our outcomes that have been published in medical journals.
As you can see, the BCIR has a long history, and we are very proud to keep Dr. Barnett's and Dr. Pollack's legacy alive. We are happy to answer your questions and provide you with a list of patients who are enjoying the Continent Intestinal Reservoir. Just email Susan Kay, R.N, or give her a call at (800) 336-0789. Don't forget to ask her to send you a CD about the BCIR procedure.
Who knows, you just might be able to make a little personal history too.
*Those with Crohn's Disease or a colostomy are usually not candidates for a BCIR.