An ostomy is a type of bowel diversion surgery, which provides a way for stool to leave the body when injury or illness prevents the large intestine from carrying out that responsibility.
The bowel is any segment of the large or small intestine in the digestive tract. The bowels help process food and remove excess water from stool before it passes through the colon and rectum to the outside of the body. Sometimes a surgeon must remove a section of the digestive tract, often in patients suffering from ulcerative colitis or familial polyposis.
Fortunately, the surgeon can choose one of three ostomy options to help the patient eliminate waste from the body.
There are three surgical ostomy options to help the body eliminate waste after surgery to remove the colon and rectum:
• Conventional ostomy
• BCIR or Barnett Continent Intestinal Reservoir
• Ileoanal J-pouch
A surgeon brings one end of the large intestine, known as a stoma, to the outside of the body. The conventional ostomy, known as the Brooke ileostomy, requires the patient wear an external pouch to catch the constant flow of stool produced by the intestine.
While most people adjust to living with an external pouch, sometimes called an ileostomy appliance or bag, some aspects of conventional ostomy can be inconvenient. Patients must empty pouches four to six times daily and change the pouch periodically. Problems may develop with the ostomy, including narrowing and skin problems.
Surgeons may be able to perform an ileostomy reversal in some patients with a conventional ostomy during an inpatient procedure. In cases where full reversal is not passible, many patients benefit from another ostomy option, BCIR. BCIR (Barnett Continent Intestinal Reservoir)
A surgeon may be able to create a Barnett Continent Intestinal Reservoir, or BCIR, which is a reservoir created from the patient’s own small intestine. The surgeon also fashions a nipple valve from the intestine that he then connects to a small stoma on the patient’s lower abdominal wall. To eliminate waste, the patient inserts one end of a tube into the stoma and the other end into the toilet bowl.
This BCIR stoma is self-sealing, so waste and gas does not come out. The patient wears a small covering over the stoma to absorb mucous.
Also known as the IPAA, the pull-through, and the J pouch, the ileoanal J-pouch procedure also involves creating a reservoir from the intestine but this time the surgeon connects the stoma to the anal canal.
Perhaps the greatest advantage to the ileoanal J-pouch is that the patient can eliminate stool normally. Patients typically have four to seven bowel movements each day rather than experience a continuous flow of stool, They can also to delay bowel movements for up to an hour after they feel the first urge.
Unfortunately, the ileoanal J-pouch does not work well for everyone. Someone with a failed j-pouch can have many stools per day and experience stool leakage out of the anus, causing chronic irritation and pain.
Surgeons now provide today’s patients with several ostomy options that offer convenience and comfort.