The Barnett Continent Intestinal Reservoir is an updated version of the Kock Pouch Continent Ileostomy. Compared to a conventional Brooke ileostomy, the BCIR requires no external appliance or bag, and restores control and freedom over the evacuation of intestinal waste. Most patients who undergo this operation have already had their colon and rectum removed and have either a standard ileostomy or a failed ileoanal J-Pouch. Some people have the BCIR at the same time as removal of the large intestine. The BCIR is considered a major abdominal intestinal surgery, and as with any operation there are potential risks and complications. These include the general risks of any operation (bleeding, infection, anesthesia reactions, etc.), as well as the specific risks of creating a BCIR or revising a malfunctioning Kock Pouch.
In Dr. Schiller’s entire career as aSurgeon he has never been sued for malpractice and has never had to defend himself against any claims. He has been a Fellow of the American College of Surgeons for 30 years. His pattern of practice is to provide personalized care to every patient, to see every patient daily after their surgery, and he does not delegate this to a Physician’s Assistant or Nurse Practitioner or Resident or Fellow. If a patient develops a complication, it will be detected as early as possible and managed appropriately to insure an optimal outcome.
Bleeding and infection are rarely encountered in Dr. Schiller’s patient outcomes. The protocols used and the surgical techniques keep these potential complications to less than 2%. In addition, Dr. Schiller has never had a patient die as a result of BCIR surgery in his 25 years of performing this surgery.
The most common risks of BCIR (or Kock Pouch) surgery is slipped valve and fistula. The valve for the BCIR is fashioned from the patient’s own intestine. If it slips out of proper position, the patient will have difficulty inserting their drainage catheter and will have incontinence of stool and gas from the stoma. The “intestinal collar” of the BCIR compared to the Kock pouch has reduced this complication to a minimum (under approximately 10% during the lifetime of the patient). A fistula is an area of abnormal healing of the pouch which results in the formation of a tract between the pouch internally and the skin incision or stoma externally. A localized abscess forms that then drains gas or stool. In Dr. Schiller’s practice the risk of a fistula involving the pouch or valve segment is less than approximately 5% during the lifetime of the patient with a pouch. Finally, there are patients whose body will not accept this “re-designing” of the intestinal tract, and because of persistent complications or intractable pouchitis, the BCIR must be removed and the patient must thereafter live with a conventional ileostomy. The history of Kock Pouch surgery since 1969 indicates that nearly 75% of people will still have a functioning healthy pouch over 30 years later. In Dr. Schiller’s practice, approximately 90% of patients still retain their pouch.