Ileostomy Options

This website is about ostomy options, especially ileostomy options and ileostomy reversal. The information is for people who need to undergo removal of their large intestine (colon) and rectum (proctocolectomy) – usually for Ulcerative Colitis or Familial Adenomatous Polyposis. It is also for people who have already had surgery and are living with the type of ostomy called an ileostomy who are candidates for ileostomy reversal surgery. It is also for people with a malfunctioning Kock pouch or failed J-pouch. There is information about the different types of stomas and ostomy options, including dietary and stoma care concerns. Ulcerative Colitis surgery (removal of colon) is usually required when medical colitis treatment management fails or there is a risk of cancer. Colitis treatment fails in ulcerative colitis (sometimes called ulcerated colitis) in up to 50% of patients. This website is about avoiding a stoma or ostomy, or if you already have an ileostomy, this will give extensive information about ileostomy reversal.

There are three surgical options for eliminating intestinal waste after surgery to remove the colon and rectum. These include the BCIR or Barnett Continent Intestinal Reservoir – a major modification of the original Kock Pouch Continent Ileostomy, the conventional or traditional ostomy known as the Brooke ileostomy, and the ileoanal J-pouch (also known as the IPAA, the pull-through, and the J pouch).

The conventional or traditional ostomy - the Brooke ileostomy - requires continuous wearing of an external pouch frequently referred to as an ileostomy appliance or bag. The small intestine is a continuous flow system, so the collecting device must always be worn. Most people do make a good physical and emotional adjustment to living with an external pouch sometimes referred to as the ileostomy bag, and have a good quality of life. However, they do not have control over their elimination. Also, the stoma must protrude above the skin for nearly one inch so the waste flows into the ileostomy bag and does not contact the skin which can be burned by the waste. Food blockages do occur with a traditional ostomy stoma, and an ileostomy diet may need to avoid roughage. The operation of “ileostomy reversal” involves taking down the existing stoma, and creating the internal BCIR or Barnett Pouch. Ileostomy reversal involves in-patient surgery.

The BCIR (or any type of Kock pouch) involves creating a reservoir from the patient’s own small intestine, as well as a nipple valve which connects to a small stoma (ostomy) on the lower abdominal wall. The nipple valve is fashioned from the intestine and is not a device of any kind. It is self sealing so no waste or gas comes out of the stoma until the patient goes into the bathroom and painlessly inserts a tube (intubating) and the waste flows through the tube into the toilet bowl. This is usually done from 3 to 5 times daily. Only a small covering is worn over the BCIR stoma to absorb mucous. The ostomy itself is flat and does not need to protrude above the skin. Each tube (catheter) lasts for months. The BCIR is significantly different from the Kock Pouch because it has an intestinal collar to help prevent slipping of the valve, as well as a different configuration of the pouch, designed to help prevent fistula (abnormal healing with communication to the skin from the intestine). For people living with a conventional ostomy, the continent ileostomy operation can transform their lives and make ileostomy reversal surgery a wonderful option.

The ileoanal J-pouch operation involves creating a reservoir from the intestine and connecting it to the anal canal. The usual outcome is having from 4 to 7 stools per day, and being able to defer a bowel movement for up to an hour from the first urge. Unfortunately, a significant percentage of patients with the J-pouch operation have a poor outcome. A failed j-pouch can involve many stools per day, incontinence with stool leaking out of the anus without control, and chronic irritation and pain. People with a failed J-pouch can undergo creation of a BCIR (Barnett type of Kock Pouch), thereby avoiding a conventional ostomy with its external appliance. If a failed J pouch has already been removed and there is a conventional stoma, ileostomy reversal surgery can be performed.

People who have undergone the Kock pouch operation over the years can develop complications, as is true of all the surgical options. Difficulty with intubation (inserting the drainage tube/catheter) can occur, as well as incontinence of waste and/or gas, or a fistula can develop (an abnormal connection between the pouch and the abdominal skin). Surgical revision of a malfunctioning Kock pouch allows for the pouch to be transformed into the BCIR using the Barnett pouch technique with its intestinal collar design. This revision avoids the need for a traditional ostomy.

The difference between the BCIR or Barnett Pouch and a conventional ileostomy is control. The BCIR is the freedom option of ileostomy reversal. It restores control over the elimination of intestinal waste to the patient. You now control your evacuations, being able to defer them for long periods of time during the day until convenient. You will sleep through the night not needing to worry about an external ileostomy pouch coming loose and leaking. You will be able to sleep prone – lying flat on your stomach. You will be unlimited in physical activities, and intimacy will be easier. If you are limited by a failed J pouch, you can avoid having a stoma (ostomy) and regain the quality of life you deserve.

If you are a person unhappy with your Brooke ileostomy, or if you have a malfunctioning or failed ileoanal J-pouch or Kock pouch, or if your colitis treatment has failed, this website will provide information about the BCIR – the Barnett Continent Intestinal Reservoir, and ileostomy reversal. It will demonstrate the difference between a typical ostomy and a continent ostomy. If you are facing removal of colon surgery (colectomy), or are not satisfied with wearing an ileostomy bag and all that is involved with ileostomy care, you will find information about how ileostomy care and ileostomy diet differs for people with a BCIR or properly functioning Kock Pouch compared to a conventional stoma. For prospective patients, we can provide patients to speak with who have been through ileostomy reversal surgery and have experienced the difference it has made in their lives. Feel free to contact us for more information and for any questions.