The Continent Ostomy Centers are proud to help others through education. These answers that follow contain general information. Consult your doctor about specific treatments and any questions regarding your care.

General Continent Ostomy Reservoir Questions:

• How do you decide when it is time to have this operation, especially if colitis is controlled ?
• I live in a town with one GI doctor and am worried about the doctor's response.
• How can you tell the difference between ulcerative colitis and Crohn's?
• Is there pain involved with intubation? What kind of irritation does it cause for the valve? What if waste is too thick, will it not come out?
• What is the recovery time ?
• How long is surgery for conversion ?
• Do you have to take any supplements after the surgery?
• Is there any regular medication you are on after the surgery?
• What happens if you are in a strenuous occupation over time with the surgery?
  Are there any complications that may occur?
• Are there any contraindications for having this surgery?
• Can not lubricating cause valve slippage?
• Can a valve perforate?
• What is the connection between male sexuality and a pouch?
• What is the youngest age you have operated on? Oldest age?
• Would it be a good idea to donate my own blood before surgery?
• What does the procedure cost?
• What happens if you lose a catheter?
• Is the incision in the same place as the stoma?
• What is the recommended length of stay after the surgery?
• Is the procedure done outside the U.S.?
• Why isn't the procedure done in Crohn's patients?
• Can you have children after you have the BCIR procedure?
• If you are unhappy with the BCIR, can you revert back to any other surgery?
• Are blockages as common as with other surgeries?
• Are there any foods that are difficult to eat?

How do you decide when it is time to have this operation, especially if colitis is controlled?

Answer: The duration of the active colitis, even if controlled, is related to the incidence of development of colon cancer. Regular colonoscopy examination with biopsies can show dysplasia, which is a pre-malignant finding. This would be an indication for surgery.

I live in a town with one GI doctor and am worried about the doctor's response.

Answer: The best way to maintain a good relationship with your doctor is to have direct communication between the BCIR surgeon and the local physician, to include the local physician in the plans, follow-up care and nature of the surgery.

How can you tell the difference between ulcerative colitis and Crohn's?

Answer: In most patients, the difference between ulcerative colitis and Crohn's colitis can be made on the basis of colonoscopy, biopsies and barium enema X-ray.

Is there pain involved with intubation? What kind of irritation does it cause for the valve? What if waste is too thick, will it not come out?

Answer: There should not be any pain with intubation. As long as there is adequate lubrication there will not be any irritation to the valve. If the intestinal waste is very thick, it may require thinning agents such as grape or prune juice or lactulose.

What is the recovery time?

Answer: The recovery time after major abdominal surgery is 12 weeks to return to strenuous activity and to have normal energy levels. Many people recover much sooner than 12 weeks and return to non-strenuous employment within four weeks of surgery.

How long is surgery for conversion?

Answer: The duration of the operation depends on individual factors and the extent of adhesions from any prior surgery, and could last from 2 1/2 to 4 hours.

Do you have to take any supplements after the surgery?

Answer: Most patients do not require any supplements after surgery.

Is there any regular medication you are on after the surgery?

Answer: There are no regular medications required after BCIR surgery.

What happens if you are in a strenuous occupation over time with the surgery? Are there any complications that may occur?

Answer: As long as the incision and stoma area have healed strongly, there is only a slight possibility of a hernia developing (an incisional hernia or a parastomal hernia). As is true with any abdominal stoma, direct trauma to the area should be avoided.

Are there any contraindications for having this surgery?

Answer: The only absolute contraindications for this surgery are abnormal small intestine (as in Crohn's enteritis) or a short small intestine (length of intestine varies among humans and after surgery).

Can not lubricating cause valve slippage?

Answer: Failing to lubricate will not cause valve slippage unless force is required to remove the catheter after the pouch is empty.

Can a valve perforate?

Answer: A valve fistula can develop with leakage of intestinal waste or gas through the stoma. This can happen in the early morning after surgery. A valve can be perforated by using severe force to insert a catheter when there is difficulty with intubation.

What is the connection between male sexuality and a pouch?

Answer: There is no connection between male sexuality and a pouch except for the benefits of not having an external appliance with a conventional ileostomy.

What is the youngest age you have operated on? Oldest age?

Answer: A person needs a certain amount of maturity to have a continent ileostomy and the growth period of adolescence should be finished before surgery. The oldest patients have been in their 70s.

Would it be a good idea to donate my own blood before surgery?

Answer: It is rare for a patient to require transfusion for surgery to convert a malfunctioning Brooke ileostomy to a continent ileostomy. However, if a person desires, one or two units (pints) of blood can be donated in the three to four weeks prior to surgery, as long as the patient takes iron to restore their blood count.

What does the procedure cost?

Answer: The average costs are $60,000 - $80,000. The largest part is the hospital bill -- 90 percent is due to a two week stay. Usually consists of surgeon, assistant surgeon and anesthesiologist. The hospital will work with you on the front end and your insurance to see what is covered. Check into the medical loan program at the hospitals.

What happens if you lose a catheter?

Answer: Every hospital in the world has Foley catheters of various sizes which can be used temporarily instead of the usual 30 French Silicon type intubation catheters.

Is the incision in the same place as the stoma?

Answer: The incision most often used is a midline (vertical) incision. The stoma for the BCIR is placed just above the pubic hair area of the abdominal wall.

What is the recommended length of stay after the surgery?

Answer: Length of stay varies depending on the individual circumstances and details of surgery. Length of stay can be as short as nine to ten days, or as long as 15 to 21 days.

Is the procedure done outside the United States?

Answer: The Barnett modification or version of the Kock pouch continent ileostomy is only done in the United States at this time.

Why isn't the procedure done in Crohn's patients?

Answer: We have learned that the possibility of failure, which means removal of the internal pouch, is four times higher in Crohn's colitis compared to ulcerative colitis or polyposis.

Can you have children after you have the BCIR procedure?

Answer: A woman may have children through normal vaginal delivery or by Caesarian section. Men may father children after the BCIR procedure.

If you are unhappy with the BCIR, can you revert back to any other surgery?

Answer: If the BCIR is not satisfactory for a given person, and this can happen for a variety of reasons, then it may ultimately be removed, reverting to a permanent, conventional Brooke ileostomy with an external appliance.

Are blockages as common as with other surgeries?

Answer: Blockages can occur from adhesions after any internal surgery, but are no more common with the BCIR. Food blockages are less common with the BCIR than with the conventional Brooke ileostomy.

Are there any foods that are difficult to eat?

Answer: Many people with a BCIR eat all types of food, but do take care to chew their food well. Foods that are difficult to digest for anyone, such as mushrooms or olives or potato skins, etc.

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