Patients with intestinal conditions such as Familial Adenomatous Polyposis, Ulcerative Colitis or cancer can often benefit from the removal of the large intestine and colon. However, when this surgery is performed, the patient must have an additional operation known as an ileostomy. The purpose of the ileostomy is to pull the small intestine through an opening in the skin for the evacuation of waste.
Physicians have been in search of a viable ostomy solution since the early 1900s. Several different ostomy options have been developed. Some of these methods include:
In a Brooke ileostomy, the end of the small intestine is rerouted through the abdominal wall and then sutured to the skin. The ileum itself becomes the stoma in this type of surgery. The stoma is located on the right side of the abdomen, and fecal output flows constantly. Thus, a collection pouch must be worn at all times and emptied on a regular basis.
Another ostomy option is the ileoanal reservoir, which may also be called a J-pouch. In this type of surgery, the surgeon constructs a pouch from the ileum. The pouch is placed inside the pelvis and is connected to the anus. Waste is stored in this pouch and then passed out of the body through the anus.
A continent ileostomy involves creating a pouch out of the ileum and placing it inside the abdomen. Part of the ileum is formed into a valve, and the pouch can be emptied several times each day with a small catheter. The pouch created is either a Koch pouch or a Barnett Continent Intestinal Reservoir (BCIR). While the Koch pouch was the first type of pouch used in this operation, a BCIR offers several advantages, including a lower chance of fistulas and leakage.
Each type of ostomy has its own advantages and disadvantages. For example, Brooke ileostomies effectively resolve intestinal problems, but they require an external collection bag, which can be embarrassing for patients. Ileoanal reservoirs allow the patient to continue passing waste through the anus, but the consistency of stool can vary, especially when the patient eats certain foods, and leakage is a possibility. Finally, continent ileostomies eliminate the need for an external storage or dietary changes, but patients must use a catheter to empty the bag 2 to 5 times daily.
For patients who dislike the idea of wearing a collection bag and want to minimize the possibility of soiling themselves between pouch evacuations, the continent ileostomy with a BCIR is often the best choice. Unlike the Brooke ileostomy, which always requires a collection bag, continent ileostomies require no bag and are much more discreet. Furthermore, unlike the ileoanal reservoir, which may leak if it isn’t emptied enough, a continent ileostomy with BCIR is unlikely to leak.