The Kock Pouch and BCIR have provided comfort and convenience for nearly 50 years to patients who needed certain types of surgery for severe bowel disease.

More than two million Americans suffer from severe bowel disease, including ulcerative colitis, Crohn’s disease and cancer, according to the BCIR website. In some cases, patients require removal of the entire small intestine when an injury or disease prevents the large intestine from safely processing intestinal waste.

Until the late 1960s, the only treatment choice available to these patients was a Brooke ileostomy, a procedure that brings the end of the small intestine, known as a stoma, to the outside of the patient’s abdomen. Intestinal waste moves from the patient’s digestive tract through the stoma to the outside of the patient’s body. After a Brooke ileostomy, patients cannot control fecal output and must therefore always wear and regularly empty the collection pouch.

Today, many patients have the option of a Kock Pouch or BCIR. Medical professionals sometimes refer to the Kock Pouch or BCIR as a continent ileostomy because patients can control when to expel the fecal material. Patients do not need to wear an external collection pouch – they simply insert a soft, thin catheter tube into a nipple valve to drain the waste from their bodies.

A surgeon creates an intra-abdominal continent ileostomy by looping part of the small intestine back on itself to create a reservoir or pocket inside the abdomen. The doctor uses part of the intestine to create a nipple valve that prevents stool and fecal material from leaking out.

History of the Kock Pouch and BCIR

Swedish surgeon Dr. Nils Kock made the first continent intestinal reservoir in 1969. By the early 1970s, many major hospitals in the United States were performing the Kock pouch procedure on patients with ulcerative colitis and familial polyposis, an inherited disorder characterized by cancer of the large intestine and rectum.

Valve slippage plagued the early Kock pouches, sometimes causing leakage or making it difficult to insert the catheter. Stomawise, an ostomy support charity, says the early versions had a 40 percent failure rate due to valve slippage. Surgeons had to revise or even remove many of these early pouches to give patients a better quality of life. Today, improvements to the procedure have perfected the Kock pouch.

Dr. William Barnett, developed The Barnett Continent Intestinal Reservoir or BCIR procedure that modified the Koch pouch by adjusting the length of the valve and developing a “living collar” to keep the valve from slipping.  The BCIR has decreased the occurrence of CIR valve slippage to less than 10 percent.

Dr. William O. Barnett began modifying the Kock pouch in 1979 by adjusting the length of the valve and by developing a “living collar” that keeps the valve from slipping out of place. This surgeon named the procedure The Barnett Continent Intestinal Reservoir (BCIR).

Kock pouch and BCIR are viable options for patients in need of ileostomy but who do not want to wear an external pouch.