Continent ileostomy modifications

Today’s discussion topics included the Barnett continent intestinal reservoir.

Worsey J, Fazio VW. (2017). Continent Ileostomy. In: Current Therapy in Colon and Rectal Surgery, 3rd ed, pgs. 204-208. Elsevier: NY.

Full-text for Emory users.

Philadelphia Illustration Dept./Elsevier

FIGURE 40-3. Barnett modification of the continent ileostomy. (Cleveland Clinic Center for Medical Art & Photography.)

“The first major modification to the basic Kock design was described by Barnett in 1987. He constructed an isoperistaltic valve and then wrapped a segment of bowel contiguous with the pouch around the exit conduit as it left the pouch (Fig. 40-3). A T pouch was described by Kaiser in 2002, based on one used by his urology colleagues. A nonintussuscepted valve mechanism was created by anchoring and opening an isolated bowel segment into a serosa-lined trough formed by the base of two adjacent ileal segments that constitute the pouch (Fig. 40-4). These pouches have their advocates but do not seem to be any easier to create technically or to give results superior to the most current modification of the original design.” (pgs. 204-205)

Kelley SR, Dozois EJ. (2019). Ulcerative colitis. In: Colorectal Surgery: A Companion to Specialist Surgical Practice, 6th ed., pgs. 117-134. Elsevier: NY.

Full-text for Emory users.

“Proctocolectomy with continent ileostomy: Initially described by Nils Kock, the continent ileostomy still remains a viable alternative for motivated patients who are not candidates for an IPAA, but is only performed in a very few centres. Modifications and revisions to the original Kock continent ileostomy have been described and include the Barnett continent ileostomy reservoir (BCIR) and T-pouch, neither of which has supporting data to suggest they are better than the Kock pouch. Contraindications to construction of a continent ileostomy include Crohn’s, obesity, marginal small bowel length, and anyone with a psychological or physical disability that would preclude understanding or being able to perform daily stomal intubation.” (p. 126)

Shen B. (2018). Endoscopic Evaluation of Surgically Altered Bowel in Patients With Inflammatory Bowel Diseases. In: Interventional Inflammatory Bowel Disease, pgs. 141-159. Elsevier: NY.

Full-test for Emory users.

PowerPoint Presentation

Figure 12.9. Anatomy of a Barnett Continent Intestinal Reservoir (BCIR). (A) Needle-knife treatment of strictured valve; (B) the valve (red arrow) wrapped around by a small bowel loop (green arrow); (C) the bowel loop around the valve (green arrow); (D) the pouch inlet. (p. 150)

More PubMed results on continent ileostomy.

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