Also called: ileoanal anastomosis; pullthrough, endorectal pullthrough, pelvic pouch or a combination of these terms.
This is now the most common alternative to the conventional ileostomy. In this procedure the colon and most of the rectum are surgically removed and an internal pouch is formed out of the terminal portion of the ileum. An opening at the bottom of this pouch is attached to the anus such that the existing anal aphincter muscles can be used for continence.
This procedure should only be performed on patients with ulcerative colitis or familial polyposis, and who have not
previously lost their rectum or anus.
Kock pouchA reservoir pouch created inside the abdomen with a portion of the terminal ileum. A valve is constructed in the pouch which is brought through the abdominal wall. A catheter or tube is inserted into the pouch several times a day to dreain feces from the reservoir. This procedure has generally been replaced in popularity by the j-pouch.
A newer version of the Kock pouch, done at a limited number of facilities. With the BCIR surgery, the large intestine is removed, including the rectum. The small intestine is pulled down and fashioned into a reservoir and then attached to the lower abdominal wall. There is an internal "valve" which makes this a "continent" ileostomy.
A stoma is created on the skin's surface, through which a catheter is inserted in order to drain waste. Because the large intestine is absent, output is usually liquid in
There are two main continent procedure alternatives (listed below) to the ileal or cecal loop (others exist).
In both of these procedures a reservoir or pouch is created inside the abdomen with a portion of either the small or large bowel. A valve is constructed in the pouch and a stoma is brought through the abdominal wall. A catheter or tube is inserted several times daily to drain urine from the reservoir.
In this version of the continent urostomy (similar to that used as in ileostomy alterantive), the pouch and a special "nipple" valve are both made from the small bowel.
In this version the ileocecal valve that is normally between the large and small intestines is relocated and used to provide continenece for the pouch which is made from the large bowel.