Nearly 50 years ago Dr. Nils Kock devised the Kock Pouch Continent Ileostomy, thereby giving patients with a conventional Brooke ileostomy wearing an external bag control over their elimination and freedom from “the bag”. Since Dr. Kock’s early work, other Surgeons have modified his technique including Dr. William O. Barnett who created the BCIR or Barnett Continent Intestinal Reservoir. His original pouch was hand-sewn, had a small, tight capacity, and he kept patients in the hospital for three weeks. For 17 days an indwelling tube going into the pouch through the stoma provides continuous decompression, and then 3 days of instruction by the nursing staff.
The BCIR itself has undergone an evolution. Over 10 years ago surgeons began to construct the pouch using modern-day surgical stapling devices. This results in a low pressure, greater capacity pouch from the outset. At Olympia Medical Center in Los Angeles, California, Surgeon Don J. Schiller, MD, FACS has lowered the length of stay to 2 weeks, with the same excellent long-term outcomes. There are 12 days of continuous decompression, and 2 days of instruction. It is a rare patient in our experience who needs to stay for a third day of nurse supervised self-catheterizations. Patients are all located on a dedicated BCIR nursing unit, and all have private rooms. A significant other can stay in the patient’s room the entire hospital stay if desired.