Your Ostomy Options

When a patient needs to undergo removal of their large intestine (the colon and rectum), a new pathway for the evacuation of digestive waste is necessary. There are three options for patients who udergo total proctocolectomy.  The QLA serves the needs of individuals with the first two of three Ostomy Options.

1. Continent Intestinal Reservoir (CIR)

Koch Pouch
This operation was devised by Dr. Nils Koch in Sweden in 1969. It involves removing the colon and rectum and anal canal in the traditional way. At that point a pouch is created from the patient's own small intestine together with an intestinal valve. This is not a foreign device or object of any kind but is a doubled layer of small intestine. It is then brought as a stoma through the abdominal wall.  The stoma is a small opening that does not protrude from the abdominal wall.

Barnett Continent Intestinal Reservoir
In 1979, Dr. William O. Barnett began making modifications to the Koch Pouch procedure. The major modifications include a collar made from a piece of the patient’s own intestine, an isoperistaltic valve and a laternal pouch. These modifications attempt to reduce the incidence of the most serious complications of continent  intestinal reservoirs, which include slipped valves and fistulas.  The intestinal valve creates a self-sealing pouch so that stool or gas will not escape.

Both styles of CIR use catheter insertion (intubate) through the stoma to drain their stool from their pouch.  The majority report no to little pain associated with intubation with frequency of 2 to 5 times daily.  Some report more freqent intubation, depending on their own metabolism.

2. Ileoanal (J Pouch)

The operation that has been performed since the early 1980's involves removing the colon and the rectum leaving the anal sphincter muscle intact. An internal pouch is created from the small intestine and connected to the anal sphincter muscle. This operation goes by many names including J-pouch, ileoanal pouch, the pull-through procedure, and the IPAA (ileal pouch-anal anastomosis).

3. Conventional Brooke Ileostomy

The procedure that has been performed for the longest period of time, since the mid-1950's, involves removing the colon and rectum including the anal opening and creating a conventional Brooke ileostomy. The end of the small intestine is brought through an opening in the abdominal wall and sewn to the skin to create a projecting stoma about 3/4 inch long. This enables the intestinal waste to flow directly into the appliance, which is glued onto the skin around the intestinal stoma itself. Since the small intestine is a continuous flow system the patient must permanently and always wear the appliance.