Gary Woodward's Inspiring BCIR Surgery Story

Brenda, a BCIR patient, discusses her life after converting from a standard Ileostomy with an external bag to the internal pouch

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Ileostomy Frequently Asked Questions

1. What are the indications for this operation?

• Ulcerative colitis not responding to medical treatment or at risk for cancer and familial polyposis.
• The presence of a conventional ileostomy requiring an external appliance.
• Patients who have undergone the ileoanal J-pouch surgery and who are troubled by excessive frequent bowel movements or lack of control with soiling themselves.
• People who have previously undergone a Kock pouch operation and are having difficulties can have it transformed into a Barnett pouch.
• There are miscellaneous reasons including multiple colon tumors and patients in whom the colon was injured from trauma.

2. How can you tell the difference between ulcerative  colitis and Crohn's disease?

In most patients the gastroenterologist treating the patient can tell the difference by colonoscopy and biopsy. Some patients have "indeterminate colitis" with features of both conditions. These patients can also have a BCIR continent ileostomy.

3. Should you have this operation if your ulcerative colitis is controlled?

This will depend upon your treating physician, but complications associated  with the disease can lead to removal of the colon or developing changes indicating a high risk of cancer.

4. Why don't you do the procedure on Crohn's patients?

Studies have shown that there is a higher risk of failure and complications  associated with Crohn's disease, even if the disease has been limited to the large intestine and has never affected the small intestine.

5. Are there any contraindications to having the surgery?

The two conditions that make it unsafe to have this operation are active Crohn's disease involving the small intestine and an inadequate length of small  intestine.

6. Will I have to take any supplements after the surgery?

Most patients do not require any nutritional or enzyme supplements after surgery but everyone should have a routine complete blood count (CBC) every  year.

7. Are medications required routinely after the  surgery?

Most patients do not require any regular medications following BCIR surgery.

8. Is the intubation process painful? Does it cause  irritation? What if the waste material is very thick, will it come out?

Intubation is done easily with the use of a flexible catheter that should  easily pass through the stoma opening into the pouch. There will not be any pain or irritation as long as the passageway is lubricated. Natural mucous that  develops can be adequate in some people. For patients with thick waste material there are ways to adjust the diet to thin the output and people find it helpful  to take grape juice or prune juice or lactulose.

9. What is the recovery time?

Most people feel quite well when they leave the hospital and are eating and  functioning normally. However, as with any major abdominal surgery returning to  strenuous activity or physical exertion must wait 12 weeks from the day of  surgery. Many people return to non-strenuous employment within 3-4 weeks from the date of surgery.

10. What is the youngest and oldest age person you have operated on?

A certain amount of maturity and self-awareness is required to have a  continent ileostomy so we usually wait until completion of adolescence. The  youngest patient was a mid-teenager. Patients in their 70s have very  successfully undergone this operation.

11. Will I need a blood transfusion? Should I donate some of my own blood before surgery?

It is rare for a patient to require transfusion for this type of surgery. It is possible to arrange for one or two units of blood to be donated prior to  surgery if desired.

12. What does the procedure cost and is it covered by  my health insurance?

A patient who is undergoing surgery to create a new BCIR will spend about two  weeks in the hospital. The last two days are spent devoted to instruction in the  care of the pouch. The cost of two weeks in the hospital and the fees for  surgery and anesthesia usually together total $60,000 - $100,000 although the  amount varies. This procedure is covered by health insurance plans as well as Medicare. For patients whose health insurance involves a managed care network or HMO, out-of-network benefits are utilized if there is no surgeon in network who performs this operation. Dr. Schiller and his office staff often write letters  on behalf of patients to enable the authorization process

13. How long does the operation take?

The surgery for conversion from a conventional Brooke ileostomy to the BCIR  could last from 2 1/2 to 4 hours depending on the extent of adhesions (scar tissue) from prior surgery.

14. What is the stoma like and where is it placed?

Unlike a stoma for a conventional ileostomy which protudes, the BCIR stoma is  flat. It is placed just above the pubic hairline in the abdominal wall to the  right of midline.

15. How long can I expect to stay in the hospital  after surgery?

Most patients undergoing surgery to convert a conventional ileostomy stay in the hospital 12-14 days. You will be taught how to do the intubation (drainage) process and will be comfortable with it at the time of discharge.

16. Are there risks if you are in a strenuous  occupation following this surgery?

As with any abdominal operation there is a small risk of a hernia developing (a weakness of the muscles where the incision or the stoma is located). However,  many patients do weight lifting and have strenuous occupations without ever developing any problem.

17. What happens if you lose your  catheter?

Every emergency room and hospital has bladder catheters of many sizes called Foley catheters which can be used temporarily until you get the type of catheter you usually use.

18. Can a women bear children after a BCIR procedure?

Many BCIR patients have had children through normal vaginal deliveries and by Caesarian section.

19. Is there a connection between male sexual function and a BCIR pouch?

No, there is no relationship between a patient with a BCIR and any male  sexual dysfunction. In fact, there is a definite benefit shown in studies for many people in terms of sexual intimacy when not requiring an external appliance  with a conventional ileostomy.

20. Will I need to limit my diet after surgery?

Most people with a BCIR eat anything they want although some foods take  longer to evacuate than others. The very fibrous foods can be more difficult to  digest. You will be provided with full information regarding dietary issues after surgery.

As a general rule, as long as you are in a place where the water is safe to  drink, it is safe to use that water to irrigate your pouch or rinse or wash your catheter. However, if the water is not safe to drink, then you must use bottled  or treated water not only for drinking but for cleaning your catheter.

21. If I am unhappy with the BCIR or it doesn't  work properly, what are my options?

For a variety of reasons a continent ileostomy will not be successful for every person. A surgical revision may be needed to correct a malfunction - this is usually highly successful. For the very few patients whose body will not tolerate an internal pouch it can be removed, returning to a conventional Brooke ileostomy with an external appliance.

22. Should I be concerned or worried about my local  primary doctor's response to my having this operation?

It is easy for me as your BCIR surgeon to have direct communication by mail  and by phone when necessary with your local physicians. We can provide a professional packet of information to your physician before surgery and continue  to provide information after the operation has been performed. People have come to Los Angeles from all over the fifty states including Alaska. People have come from small towns and from large cities. One of the reasons for the success of  Dr. Schiller's program has been excellent follow-up with local physicians.