Don J. Schiller, MD, FACS, gave the H. Earl Gordon Memorial Lecture to the Wadsworth Physicians & Surgeons Alumni Association Recently at their Annual Scientific Seminar titled: “Ileostomy Options and Continent Diversions."
Online PR News – 07-April-2012 – Los Angeles, CA – Don J. Schiller, MD, FACS, gave the H. Earl Gordon Memorial Lecture to the Wadsworth Physicians & Surgeons Alumni Association Recently at their Annual Scientific Seminar titled: “Ileostomy Options and Continent Diversions.”
This presentation was about people who require complete removal of their colon (large intestine) and rectum. The most common reasons for this surgery are Chronic Ulcerative Colitis and Familial Adenomatous Polyposis. Additional diagnoses include Crohn’s (granulomatous) colitis, colonic inertia, multifocal colon neoplasm, and trauma.
The operation of proctocolectomy is associated with three options for patients to evacuate digestive waste: conventional Brooke ileostomy, ileoanal J pouch, and continent ileostomy (Kock type pouch including its modification known as the BCIR or Barnett Continent Intestinal Reservoir).
Since the small intestine is a continuously flowing system, a patient with a conventional Brooke ileostomy will always need to wear an external pouch, often referred to as external appliance or bag. There will always be flow of intestinal effluent into the collecting device. The stoma itself must protrude above the skin to form a spout as the effluent is corrosive to skin. An ideal outcome includes changing the appliance once a week or so, emptying multiple times daily, and being unlimited in activities.
The ileoanal J pouch procedure involves removal of the entire colon and nearly all of the rectum, leaving the anal canal with its innervation, and usually part of the transitional zone of the lower rectum. A pouch is created from the small intestine and connected to the anorectum. Bowel evacuations are done in the usual manner as before surgery. Outcome measures include stool frequency (normal range 3-7 times daily), continence, pouchitis, monitoring of the residual rectal transitional zone, complications and failures.
The Kock pouch continent ileostomy was developed prior to the ileoanal J pouch. This operation involves removal of the colon and rectum, and creation of an intestinal pouch with a nipple valve fashioned from the intestine. There is a small, non-protruding stoma, and patients self-catheterize with a 30Fr. silicone catheter to evacuate waste (normal range 2-5 times daily).
Outcome measures include intubation frequency, pouchitis, complications of slipped valve and fistula, and failures. The early failure rate was high due to slipping of the valve with resulting incontinence. The Kock pouch original technique has been modified especially with the addition of an “intestinal collar” utilized with the Barnett pouch technique.
Many studies have revealed high patient satisfaction with good to high quality of life scores with each of the options available. Choice of an option for a specific patient requires evaluation by the entire team, medical (primary care and gastroenterology), surgical (general or colorectal surgery), and ancillary staff.
The BCIR Continent Ileostomy is a modern day option to maintain continence and avoid a conventional ileostomy requiring an external pouch (bag,appliance). The Continent Ileostomy is an alternative for people who already have a conventional ileostomy, or for people who have had a J pouch procedure with an unsatisfactory outcome or who are not candidates for a J pouch procedure. The major advantage of the continent ileostomy option is to allow a patient to maintain control over the evacuation of their digestive waste, unlike a conventional ileostomy or a failed ileoanal J Pouch. “The BCIR is truly a Freedom Option,” says Dr. Schiller.
About Don Schiller, MD, FACS: Don Schiller, M.D., F.A.C.S., performs the BCIR option at Olympia Medical Center in Los Angeles. Dr. Schiller maintains a personal connection through regularly scheduled follow-up care either in person or by scheduled telephone appointments during the first six months post-operatively and then as needed after that. Dr. Schiller’s care is unique in that it is provided by him – not a nurse or physician’s assistant and he coordinates with the patient’s local physician.
About Olympia Medical Center
Olympia Medical Center is a physician owned hospital located in the heart of Los Angeles and has been providing medical care to nearby communities since 1948. Services at the 204-bed acute care hospital include comprehensive inpatient and outpatient services, diagnostic imaging and award winning 24-hour emergency care. The hospital is dedicated to clinical excellence and delivering health care services in a patient-centered, community focused environment. Services include the California Digestive Diseases Institute, the Los Angeles Center for Spine Care and Research, the Center for Wound Management and Hyperbaric Medicine, the Continent Ostomy Center, the Reflections Outpatient Behavioral Health Program, and the Center for Geriatric Health. Olympia Medical Center is a fully accredited hospital. To learn more about Olympia Medical Center, visit www.olympiamc.com