A retrospective outcome analysis was performed in 1994 on 510 patients who received the BCIR procedure between January 1988 and December 1991. The study was published in The Diseases of the Colon and Rectum, June 1995. All patients in this study were between one and five years post-op with an admitting diagnosis of ulcerative colitis or familial polyposis.*
Approximately 73% were conversions from conventional (Brooke) ileostomies, 9% were conversions from failed alternative procedures and 18% were primary proctocolectomies.
The study found that approximately 92% of the patients have functional BCIR pouches at least one year following surgery. As illustrated in Table 1, a total of 87.2% of patients required no or minor subsequent surgery to ensure a functioning pouch. Only 6.5% of the 510 patients required subsequent removal of the pouch. The majority of these pouch excisions (removals) occurred within the first year (63.6%).
Success Rate Of The BCIR Surgery
Major complications included valve slippage, fistula formation, and pouch leakage. Of the 32 patients treated for valve slippage, 23 achieved a fully functioning pouch. Pouch or valve fistulas affected 52 patients, 39 ultimately achieved successful results. Pouch leaks occurred in 11 patients, of these 7 have functioning pouches. The incidences of complications are listed in Tables 2 and 3.
Tables 2 & 3
Complications Associated With The BCIR
Complications not related to the pouch itself parallel those which accompany other types of abdominal surgery. The most frequent is small bowel obstruction which was seen in 50 patients, 20 of whom required surgical intervention.
The retrospective study further evaluated the impact of the operation on each patient's perceived quality of life. As Table 4 indicates, over 87% of the patients feel their quality of life is better after having the BCIR.
Quality Of life With The BCIR Compared To Previous Surgeries
If you have any more questions or concerns regarding our outcomes, please 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.
Outcome Analysis of 42 Failed J-Pouches Converted to BCIRs
A retrospective outcome analysis was performed on 42 patients who converted from a failed ileal pouch-anal anastomosis (J-Pouch) to a continent ileostomy (using the Barnett modification of the Kock pouch). The average follow-up time was 3.39 years. This study was published in The Diseases of the Colon and Rectum, April 1999.
The primary reason for conversions to continent ileostomy in all cases was incontinence, with associated skin excoriation, pain, and frequent bowel movements. Two patients also reported stenosis, and one had a pouch vaginal fistula.
The study found that forty (95.2%) patients of the failed IPAA population reported fully functioning pouches. Two were excised, one after development of a pouch vesical fistula, the other after emergence of Crohn's disease, which had not been diagnosed at the time of the original colectomy.
Eleven (26%) of our patients with failed IPAAs experienced symptoms of pouchitis, of which 3 (7%) experienced symptoms severe enough to warrant hospitalization.
The study further evaluated the impact of the operation on each patients perceived quality of life. Of the 40 patients who retained their pouch, all (100%) reported their life after the continent ileostomy as better or much better than before.
Based on the case review, we conclude that the continent ileostomy can be used as an effective treatment for patients when a primary IPAA procedure fails.
* Those with Crohn's Disease or a colostomy are usually not candidates for a BCIR.