Diseases of the Colon & Rectum

, Volume 38, Issue 6, pp 573–582 | Cite as

Barnett continent intestinal reservoir

Multicenter experience with an alternative to the Brooke ileostomy
  • Patrick Mullen
  • Donald Behrens
  • Thomas Chalmers
  • Catherine Berkey
  • Martin Paris
  • Michael Wynn
  • Daniel Fabito
  • Ronald Gaskin
  • Tyler Hughes
  • Don Schiller
  • Francis Veninga
  • Pio Vilar
  • James Pollack
Original Contributions

Abstract

PURPOSE: Since 1988, surgeons at five hospitals have been performing the Barnett continent intestinal reservoir (BCIR). The BCIR includes modifications to the original Kock pouch, designed to reduce the incidence of valve slippage and fistula formation. Principle modifications include an intestinal collar, an isoperistaltic valve, and a lateral pouch design. METHOD: This unique collaborative study includes 510 ulcerative colitis or familial polyposis patients, with a follow-up time from one to five years postoperatively. RESULTS: Ninety-two percent still have functioning reservoirs. Six and one-half percent have had their pouches removed and replaced with conventional Brooke ileostomies. Reoperation rate for major pouch-related complications (other than pouch removal) was 12.8 percent. These complications included slipped valve (6.3 percent), valve fistulas (4.5 percent), and pouch fistulas (6.3 percent). Several questions were administered to patients whose responses revealed a significant improvement in general quality of life, state of mind, and overall health. CONCLUSIONS: The BCIR represents a successful alternative to patients with a conventional Brooke ileostomy or those who are not candidates for the ileal pouch-anal anastomosis.

Key words

Coloprotectomy, restorative Ileal reservoir Ileal pouch Ileostomy J-pouch Kock pouch Proctocolectomy, restorative 

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References

  1. 1.
    Brooke BN. The management of an ileostomy including its complications. Lancet 1952;2:102–4.PubMedGoogle Scholar
  2. 2.
    Kock NG. Intra-abdominal “reservoir” in patients with permanent ileostomy: preliminary observations on a procedure resulting in fecal “continence” in five ileostomy patients. Arch Surg 1969;99:223–31.PubMedGoogle Scholar
  3. 3.
    Schrock TR. Complications of continent ileostomy. Am J Surg 1979;138:162–9.PubMedGoogle Scholar
  4. 4.
    Cranley B. The Kock reservoir ileostomy: a review of its development, problems and role in modern surgical practice. Br J Surg 1983;70:94–9.PubMedGoogle Scholar
  5. 5.
    Fazio VW, Church JM. Complications and functions of the continent ileostomy at the Cleveland Clinic. World J Surg 1988;12:148–54.PubMedGoogle Scholar
  6. 6.
    Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ 1989;2(Suppl 6130):85–8.Google Scholar
  7. 7.
    Spencer MM, Barnett WO. The continent ileal reservoir (Kock pouch): a new approach. J Enterostomal Ther 1982;9:8–13.PubMedGoogle Scholar
  8. 8.
    Barnett WO. Improving the continent ileostomy. J Miss State Med Assoc 1983;24:31–4.PubMedGoogle Scholar
  9. 9.
    Barnett WO. Modified techniques for improving the continent ileostomy. Am Surg 1984;50:66–9.PubMedGoogle Scholar
  10. 10.
    Barnett WO. Continent intestinal reservoir. South Med J 1987;80:1262–5.PubMedGoogle Scholar
  11. 11.
    Barnett WO. Current experiences with the continent intestinal reservoir. Surg Gynecol Obstet 1989;168:1–5.PubMedGoogle Scholar
  12. 12.
    Sheperd NA, Hulten L, Tytgat GN,et al. Pouchitis. Int J Colorectal Dis 1989;4:205–29.PubMedGoogle Scholar
  13. 13.
    Madden MV, Farthing MJ, Nicholas RJ. Inflammation in ileal reservoirs: ‘pouchitis’. Gut 1990;31:247–9.PubMedGoogle Scholar
  14. 14.
    Cohen Z. Current status of the continent ileostomy. Can J Surg 1987;30:357–8.PubMedGoogle Scholar
  15. 15.
    Dozois RR, Kelly KA, Beart RW Jr, Beahrs OH. Improved results with continent ileostomy. Ann Surg 1980;192:319–24.PubMedGoogle Scholar
  16. 16.
    Gelernt IM. The continent ileostomy. In: Jirsch DW, ed. Frontiers in general surgery. Philadelphia: FA Davis, 1982:313–30.Google Scholar
  17. 17.
    Kock NG, Brevinge H, Philipson BM, Ojerskog B. Continent ileostomy: the present technique and long term results. Ann Chir Gynaecol 1986;75:63–70.PubMedGoogle Scholar

References

  1. 1.a
    Dozois RR, Kelly KA, Beart RW Jr., Beahrs OH. Improved results with continent ileostomy. Ann Surg 1980;192:319–24.PubMedGoogle Scholar
  2. 2.a
    Fazio VW, Church JM. Complications and function of the continent ileostomy at the Cleveland Clinic. World J Surg 1988;12:148–54.PubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1995

Authors and Affiliations

  • Patrick Mullen
    • 1
  • Donald Behrens
    • 2
  • Thomas Chalmers
    • 3
  • Catherine Berkey
    • 3
  • Martin Paris
    • 4
  • Michael Wynn
    • 5
  • Daniel Fabito
    • 2
  • Ronald Gaskin
    • 2
  • Tyler Hughes
    • 1
  • Don Schiller
    • 6
  • Francis Veninga
    • 1
  • Pio Vilar
    • 2
  • James Pollack
    • 7
  1. 1.Department of SurgeryRHD Memorial Medical CenterDallas
  2. 2.Lutheran Medical CenterSt. Louis
  3. 3.Technology Assessment GroupHarvard School of Public HealthBoston
  4. 4.Department of Medical Staff AffairsNational Medical EnterprisesSanta Monica
  5. 5.Department of SurgerySan Ramon Regional Medical CenterSan Ramon
  6. 6.Department of SurgeryCentury City HospitalLos Angeles
  7. 7.Department of SurgeryPalms of Pasadena HospitalSt. Petersburg

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