Topic Explanation

The forum discussion revolves around the Barnett Continent Intestinal Reservoir (BCIR) procedure, an alternative to traditional ostomy methods for individuals who have had their large intestine removed. The original poster is seeking advice and experiences from others who have undergone or are contemplating the BCIR procedure. They are particularly interested in understanding the mechanics, pros, cons, and any potential regrets associated with the procedure. The BCIR involves creating an internal pouch from the small intestine, which is emptied using a catheter, eliminating the need for an external ostomy bag.

Advice and Insights

- General Information and Mechanics:
- The BCIR is an internal ostomy that eliminates the need for an external bag. Stool is emptied from an internal reservoir by inserting a catheter into a stoma on the abdomen.
- The procedure is complex and performed by specialized surgeons. It involves creating an internal pouch from about two feet of the small intestine, along with a valve and collar to prevent slippage.
- The stoma created is flush against the skin, and a gauze pad or bandage is worn over it to collect mucus.

- Candidates and Contraindications:
- Suitable for patients with conditions like ulcerative colitis, Crohn's disease, and familial adenomatous polyposis (FAP) who have had their colon and/or rectum removed.
- Not suitable for patients with Crohn's disease, obesity, certain disabilities, or short bowel syndrome.
- Patients with a failed j-pouch may consider BCIR as an alternative.

- Risks and Complications:
- Early complications can include bleeding, leakage, perforation, or necrosis in the valve.
- Long-term complications may involve valve slippage, prolapse, fistulas, volvulus, perforation hernia, valve stenosis, or pouchitis.
- Pouchitis, an inflammation of the pouch, can cause diarrhea and discomfort but is usually manageable with antibiotics.

- Aftercare and Maintenance:
- Hospital stays post-surgery can range from seven days to three to four weeks to allow for healing and adjustment to the intubation process.
- Patients need to carry a tube to empty the pouch, typically two to five times a day, depending on food intake and other factors.
- Regular follow-up with specialized surgeons is crucial due to the higher rate of revision surgeries and complications compared to traditional ostomies.

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