The original continent ileostomy operation was done in Sweden in the 1960s by Dr. Nils Kock, and ever since it has been called the Kock Pouch. Unfortunately, the early experience with the Kock pouch was filled with failures and complications. The initial enthusiasm among Surgeons, Gastroenterologists and patients decreased because of this. However, small numbers of dedicated Surgeons continued to modify the original Kock Pouch design in order to decrease complications and failures (where the pouch had to be removed and the patient had to live with a conventional ileostomy with its external appliance). In the 1980s, Dr. William O. Barnett created a very substantial modification of the Kock pouch, including the innovative design of an intestinal collar to wrap around the outside of the pouch to aid in preventing the valve from slipping. The lateral suture line replacing the triangular suture line of the Kock pouch is designed to aid in reducing the incidence of fistula. The Barnett modification of the Kock Pouch has been called the Barnett Continent Intestinal Reservoir or BCIR. Any internal pouch that allows a patient to have control over the discharge of their intestinal waste can be called a Continent Intestinal Reservoir or CIR. This includes the ileoanal J-pouch procedure as well.
The advantages of the BCIR pouch stoma is that is does not need to be elevated above the skin to form a spout as is the case with a conventional (Brooke) ileostomy. The BCIR stoma is flush with the skin. Also, since no appliance is needed, the stoma can be placed much lower than a conventional ileostomy, just a little bit above the pubic hair line to the right of midline. There are no clothing restrictions as there is no “bag bulge” without an appliance!
The main problems facing continent ileostomy surgery is the potential need for reoperation, either for a slipped nipple valve or for a fistula. When the valve slips out of position, 2 problems occur: difficulty inserting the drainage catheter, and incontinence (waste and gas now leak out of the stoma opening). A fistula is an abnormal connection between the internal pouch and the stoma or skin near the stoma or at the main incision. People who develop a slipped valve will require a revision to restore normal pouch function. People who develop a fistula may require surgery to close it.
Studies have been done comparing people with a conventional ileostomy to those with a BCIR continent ileostomy. The vast majority of people report an enhanced quality of life, a better self-image, and improved sexuality. This is consistent with the early Kock pouch studies as well as more recent evaluations.