Welcome to our 'Frequently Asked Questions' page. While we realize we cannot address every question you may have at this time, we think you'll find the following questions and answers very helpful. Let us know if you believe we have overlooked an important issue regarding the BCIR procedure.
Also, please visit our Chat Room. We will be hosting Live Chats on the first Tuesday of each month from 8 to 9 pm Eastern time, USA. Susan Kay, RN will be hosting the forums and she'll be glad to answer any more questions you may have.
A BCIR, (Barnett Continent Intestinal Reservoir) is an intra-abdominal continent pouch - all constructed from your small intestine. Also, you will have a very small skin-flush stoma on your lower right abdomen. No external appliance is necessary. The late Dr. William O. Barnett devised the BCIR in 1979 based on the Kock pouch.
- Individuals who have problems associated with the conventional ileostomy.
- Individuals who have a failed continent (Kock) pouch, failed ileal pouch anal anastomosis (IPAA) or other similar procedure.
- Individuals with poor anal sphincter control and are therefore judged not to be a candidate for the IPAA or who elect not to have the IPAA.
Determining whether or not you should have surgery will depend upon you and your physician. The usual indications for surgery would be:
- If you are one of the people who are no longer responding to medical therapy.
- You are experiencing complications associated with the disease or medications.
- You are experiencing tissue changes, or dysplasia, a pre-cancerous condition.
Yes. Approximately 80% of our patients have converted from an ileostomy, and some have had an ileostomy for as many as 30 years.
Yes. A malfunctioning Kock pouchcan be revised, including transforming it into the BCIR design.
Yes – it is important to understand that a patient with a failed J-pouch does not need to have a standard Brooke ileostomywith the external appliance!
Continent ileostomies (Kock pouches) have been around since the early 1970s. Dr. Barnett began revising the Kock pouch in 1979. The BCIR surgery has been performed at the Continent Ostomy Center at Palms of Pasadena Hospital since January 1988. The late Dr. Barnett (the creator of the BCIR) performed over 300 procedures in Mississippi prior to establishing a center in St. Petersburg, Florida, where his legacy continues.
At Palms of Pasadena Hospital, over 1000 surgeries have been performed representing 41 states. Prior to that time, Dr. Barnett performed approximately 300 cases during the development of the BCIR procedure in Jackson, Mississippi.
Success can be defined in many ways since it can mean different things to different people. In our series of 510 patients with diagnosis of ulcerative colitis or familial polyposis, 477 patients had their BCIR pouches intact at the end of the study period.
The risk of death for the BCIR procedure is no different than the risk of similar major surgery. Potential complications are dependent upon the particular patient's history. You should discuss your entire medical history with your surgeon to be fully informed.
No, it is rare for a patient to require transfusions for surgery to convert a malfunctioning Brooke ileostomy to a continent ileostomy. However, if a person desires, one or two units (pints) of blood can be donated in the three to four weeks prior to surgery, as long as the patient takes iron to restore their blood count.
A person needs a certain amount of maturity to have a continent ileostomy and the growth period of adolescence should be finished before surgery. The youngest patient was 13, the oldest patient was 74.
The two absolute contraindications are active Crohn's disease or an inadequate length of small intestine. Also, if you have a permanent colostomy, you would not be a candidate for a BCIR.
The average length of stay varies, depending on the individual circumstances and details of surgery. Generally it is between 16 and 21 days.
In the majority of patients, the difference between ulcerative colitis and Crohn's disease can be made upon the basis of a colonoscopy and biopsies. However - as you probably know - it is sometimes difficult to render a 100% definite diagnosis between Crohn's and ulcerative colitis.
Pouchitis is a nonspecific inflammation occurring in the pouch. The true incidence of pouchitis is difficult to identify because of variable criteria for diagnosis and severity. However, 73% of the 510 surveyed patients said that they did not consider pouchitis to be a major problem. It is fair to say that most patients experience pouchitis to some degree. However, in a majority of these cases, the symptoms are managed at home with oral antibiotics.
When you first leave the hospital, you should avoid fruits, nuts and vegetables that may clog the catheter. Once you are all healed and your pouch has expanded in size, you will be able to eat most any food.
If you chew your food very well, you should be able to eat just about anything. However, many of our patients avoid the tough 'skins' of apples, potatoes and tomatoes, and foods which do not digest well like corn, mushrooms, and peanuts, simply because of the difficulty in passing them through the catheter. Each individual seems to have a somewhat different tolerance for these types of foods.
Once your pouch is matured there should be no need to get up in the middle of the night unless you have eaten late or had a large meal which you are not accustomed to.
The stoma is small and skin-flush with the abdominal wall. It is usually located low on the abdominal wall. It can be located in close proximity to bony structures since one does not have to secure an external appliance.
There should not be any pain with intubation because the BCIR pouch does not have any nerve endings. Using adequate lubrication helps with the process. Some patients use a little bit of K-Y jelly and some just use a bit of tap water on the catheter before intubating.
Many hospitals in the world have Foley catheters of various sizes which can be used temporarily instead of the usual '30 French' silicon type intubation catheters. The standard catheters you will use are easily attained through medical supply houses. They can be used over and over and most cost about six dollars each.
This varies greatly with individual patients. Depending on your body's individual tendency to produce mucus, the amount of mucus drainage varies greatly. Some patients use something as small as an adhesive bandage, or a small gauze pad, while others use maxi-thin pads cut in half or small absorbent towels to contain the mucus.
Yes to the first question. This is one advantage of the continent ileostomy. Our patients wear tight bathing suits, sports wear and the like. Once your doctor and surgeon give you the green light after surgery, you should be able to resume activities you enjoyed before the surgery, such as swimming, biking, exercising and most all sports. (You might want to wear a protective device to cover the stoma area if you play softball, etc.)
The BCIR should remain continent. However, you may experience cramps which is your body signaling that you have to go to the bathroom.
When you first leave the hospital, you will be on a schedule of intubating every couple of hours or so and gradually extending the time between intubations in order to let the pouch expand in size gradually. When the pouch has matured, you may go to the bathroom when you feel the need.
Most patients say they experience a 'full' feeling. It is similar to the signal you get when you have to urinate. You'll know when it's about time to empty the pouch, but most times you can wait until it's convenient for you to intubate. If you wait too long, you may have a more intense feeling or slight ache in the pouch area.
The BCIR is an internal reservoir for intestinal waste. So whenever a patient feels a sensation of fullness in the pouch, a small catheter is inserted throughout the stoma, a surgically-created opening flush with the abdomen, and waste is emptied from the pouch directly into any toilet.
Most patients report draining the pouch 2-4 times daily, and most times they sleep through the night. This number can vary depending on the types and quantities of food you eat.
The recovery time after major abdominal surgery is 12 weeks to return to strenuous activity and to have normal energy levels. Many people recover much sooner than 12 weeks and return to non-strenuous employment within four to six weeks of surgery.
Most patients do not require supplements or routine medication after surgery. Just eat a well-balanced diet and you should be fine.
A women may have children through normal vaginal delivery or by Caesarian section with a BCIR. During the pregnancy we request your OB doctor be in contact with the BCIR surgeon.
Blockages can occur from adhesions after any abdominal surgery, but are no more common with the BCIR.
If the BCIR is not satisfactory for a given person, and this can happen for a variety of reasons, then it may ultimately be removed, reverting to a permanent, conventional Brooke ileostomy with an external appliance.
Thanks for visiting our 'FAQ' page. We hope we have answered most of your questions. If you would like more information about the BCIR, email to Susan Kay or give her a ring at 1-800-336-0789.