Surgery Options After Total Colon Removal

When the colon has to be removed, there are three surgical options available:

1) Brooke Ileostomy: here the entire colon and rectum are removed, and the small intestine continuously drains waste into an external appliance (bag).

2) Ileoanal J-pouch: with this option, the colon and the rectum are removed, but the lower part of the rectum and the anal sphincter are left intact. A pouch is created using part of the small intestine to store waste. This enables normal bowel movement with no external equipment. However, the procedure fails in 5-15% of cases, and some patients are not candidates for this option due to other complications.

3) Continent Ileostomy / BCIR: available since the late 1960s, in the continent ileostomy option the colon and rectum are removed entirely, and an internal pouch is created using part of the small intestine. Unlike the ileoanal J-pouch where the anal sphincter is left intact, with a continent ileostomy, a valve is created, also using part of the intestine. No waste or gas escapes the internal pouch until a catheter is inserted to drain the waste. The original procedure, called a kock pouch, has since been improved to create the BCIR, which gives better outcomes.


The BCIR is a type of ileostomy that replaces an external bag or appliance with an internal pouch. A catheter is inserted several times a day to empty the internal pouch. The BCIR gives people the ultimate in freedom because only a small covering needs to be placed over the stoma. No waste or gas will escape until you insert your drainage catheter.

Dr. Don Schiller is a pioneer in Barnett Continent Intestinal Reservoir (BCIR) surgery in the western United States, having learned the procedure at the hands of Dr. William O Barnett, who modified the original Kock pouch into the BCIR. Since 1989, Dr. Schiller has performed the surgery on people all over the United States and the world.

INSURANCE:
The BCIR is a well-known, approved procedure, listed in all the surgical procedure code manuals including Medicare. All health insurance carriers approve this operation. Even Managed Care companies (HMOs) will approve this surgery.

Surgery to convert a standard conventional ileostomy to the BCIR is covered by health insurance. The diagnosis is "malfunctioning Brooke ileostomy" which includes both physical problems with an ileostomy as well as emotional or psychological problems dealing with an ileostomy. Just the presence of an ileostomy requiring an external appliance is an approved indication for the BCIR surgery.


Olympia Medical Center
Los Angeles, CA
1-800-677-5252

[Mstbad]

Thanks for the video it's really helpful.