Creation of a Continent Ileostomy, either the Kock Pouch or the subsequent modification into the BCIR
or Barnett Continent Intestinal Reservoir pouch, is a major complex operation. Over the years, some
surgeons discharge a patient as soon as they can eat after surgery (this could be 5-6 days), and send
them home with a tube (catheter) sewn in place for a month. Then the tube is removed and the patient
starts to “intubate” on their own. (Intubation is the process of inserting the catheter through the stoma
opening and into the pouch, allowing the waste to flow through the tube into the toilet receptacle. This
is usually done between 3-5 times daily.)
The original protocol of Dr. Barnett in the 1980s was to keep the patient in the hospital for three full
weeks. The tube placed into the internal pouch during surgery is kept to drainage for 17 days, and then
the patient spends 3 more days in the hospital being taught intubation and supervised by the Nursing
Staff. In addition, Dr. Barnett had every patient receive intravenous nutrition (TPN) for the first 10 days
after surgery, or longer.
Additional modifications by some BCIR surgeon experts including Don J. Schiller, MD, FACS allowed for
the initial capacity of the pouch to be much larger than with Dr. Barnett’s original technique, and this
allowed patients to have their BCIR pouch catheter removed on the 12th day after the surgery. Then only
2 additional days are needed to be confident and comfortable in being able to manage with your new
Continent Ileostomy. The 3 week hospital stay is no longer warranted as results have been unchanged.
While 2 weeks is still a substantial period of time, the routine use of TPN is not needed, thereby
reducing the risks of infection and blood chemistry abnormalities, as well as decreased expense.
For additional information please call our Continent Ostomy Coordinator at 1-800-677-5252 or contact
us by email at firstname.lastname@example.org