Don J. Schiller,MD,FACS, director of the Continent Ostomy Program at Olympia Medical Center in Los Angeles, California, is celebrating his 20th year performing the Barnett modification of the Kock Pouch continent ileostomy.
Los Angeles, CA (PRWEB) November 27, 2009 -- Don J. Schiller,MD,FACS, director of the Continent Ostomy Program at Olympia Medical Center in Los Angeles, California, is celebrating his 20th year performing the Barnett modification of the Kock Pouch continent Ileostomy (for more information on the Kock Pouch, also called Koch Pouch, see: http://www.ileostomy-surgery.com/Kock_Pouch_Ileostomy.html).
The Barnett version of the Kock Pouch is also referred to as the BCIR or Barnett Continent Intestinal Reservoir. The continent ileostomy is an alternative to a conventional ileostomy (known as the Brooke ileostomy) which requires the wearing of an external appliance (or “bag”) at all times to collect intestinal waste. People who require removal of their entire large intestine and rectum for ulcerative colitis, familial polyposis, and other conditions, must have a new way created to evacuate intestinal waste. The available options include the conventional ileostomy, the ileoanal J pouch, and the continent ileostomy. The J pouch procedure is an internal pouch of the small intestine connected to the anal canal, allowing for normal evacuations (albeit 4-7 times a day). The J pouch procedure fails in up to 15% of people because of lack of control with soiling (incontinence), excessive bowel movements (more than 7 per day), and infections. When failure occurs, the patient is often told that they must have a traditional ileostomy with the external bag. However, an appliance-free option does exist – the Kock or BCIR pouch! See the Kock Pouch FAQ: http://www.ileostomy-surgery.com/Kock_Pouch_Frequently_Asked_Questions.html.
The Kock pouch procedure was devised in Sweden in the late 1960s and includes an internal pouch of small intestine, a “nipple valve” continence mechanism made from the patient’s small intestine, and a stoma. Several times a day the patient will insert a catheter (tube) into the stoma which leads to the internal self-sealing pouch. The waste passes through the catheter into the toilet. No waste or gas escapes until the tube is inserted, and nothing can enter the pouch even with bathing, swimming, or Scuba diving! A small bandage is worn over the stoma to collect mucous. This procedure gives an ileostomy patient control over their evacuation of waste. Since the small intestine is a continuous-flow system, with a standard ileostomy waste drains continuously and an external collection bag must be worn at all times. The continent ileostomy provides a storage chamber for waste, and people can go many hours between draining the pouch.
The original Kock Pouch procedure failed in a high percentage of patients. Dr. William O. Barnett (deceased) in the United States spent many years modifying the Kock technique in the early 1980s. He created a different pouch design, with an intestinal collar wrapped around the outside of the nipple valve segment, to help prevent slipping of the valve.
When the valve slips, the patient will have difficulty inserting their drainage catheter and will have leakage of waste from the stoma. The incidence of this problem was nearly 50% with the early Kock pouch technique. The BCIR has been a very useful advance to minimizing the development of this problem (see: http://www.ileostomy-surgery.com/Kock_Pouch_Ileostomy.html).
Over the past 20 years, after learning the technique from Dr. Barnett personally, Dr. Schiller has operated on many patients from around the United States and abroad. The surgery can be done as a primary procedure involving the one-step removal of the colon and rectum and creation of the BCIR. It is also done for people who have already had their colon removed and have a conventional ileostomy. In addition, people who have a malfunctioning Kock pouch are often candidates to undergo revision to a BCIR to correct problems with incontinence or difficulty with self-catheterization. Finally, Dr. Schiller has operated on many people who have undergone the ileoanal J-pouch procedure (also called the “pull-through”), and who have an unsatisfactory result. Dr. Schiller provides personalized care to his many patients, who frequently praise his commitment and dedication. Following surgery, he provides long-term care and follow-up, not delegating this to office or ancillary personnel.
For further information, please visit Dr. Schiller’s website http://www.ileostomy-surgery.com/Kock_Pouch_Frequently_Asked_Questions.html.
Contact:
The Ileostomy Surgery Center
9808 Venice Blvd, Suite 603
Culver City, CA 90232
Phone: (310) 204-4565
Fax: (310) 204-4566
http://www.ileostomy-surgery.com
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