Continent Diversions

   
Small Bowel Diversions

Diversion include:

  • Ileoanal Pouch (J-Pouch)
  • Continent Ileostomy (Kock Pouch)
  • Barnett Continent Intestinal Reservoir (BCIR)
    
Ileo-anal reservoir/J-pouch:
An internal reservoir for stool storage, made from ileum and attached to the anus to allow more-or-less normal evacuation. Includes “J-”, “S-” and “W-” variants.

Continent ileostomy/Kock pouch:
An internal reservoir for stool storage, made from ileum and attached to the abdominal wall by a special stoma/one-way valve, emptied by inserting a catheter through this stoma.


BCIR:
Barnett Continent Intestinal Reservoir (BCIR) uses your body’s own tissues to form an internal pouch, which is drained via a small catheter inserted low on the abdomen.
   
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ILEO-ANAL RESERVOIR / PELVIC POUCH / PULL- THROUGH / J-POUCH



















Procedure
The entire colon is removed. Anal muscles are preserved. Sphincter control is essential. A reservoir is constructed from small intestine and attached to the anus.

Advantages
• May cure the disease.*
• No pouching system required.
• Normal route of stool evacuation.

Disadvantages
• Often requires two surgeries.
• Higher risk of complications.
• 4-8 bowel movements daily.
• Possible peri-anal skin problems.

• Chance of pouchitis which may require periodic irrigations/medication.
• Possible irregularity and/or 
incontinence.
• Longer period of adaptation.
• Long-term results are unknown.
   

      CONTINENT ILEOSTOMY / ABDOMINAL POUCH / KOCK POUCH / BCIR



















      
Procedure
Colon, rectum and anus are removed. An internal reservoir with a nipple valve is constructed. The opening is on the abdomen.

Advantages
• May cure the disease.*
• A patch to absorb moisture is the 
only external equipment needed, i.e., no pouching system needed.

Disadvantages
• Highest risk of complications, operation revision is often required.
• Must intubate to empty 2-4 times daily.
• Chance of pouchitis which may require periodic irrigations/ medication.
• Long-term results are unknown.




For more information on Small Bowel Diversions, or to see if you might be a candidate for one of these types of surgeries, please visit www.ostomy.org

Urinary Diversions

Diversions include:

  • Continent Urostomy (Kock Pouch)
  • Indiana Pouch
  • Orthotopic NeoBladder

Kock Pouch (“coke”): made from approximately two feet of ileum. The ureters are connected to an internal valve which prevents reflux to the kidneys and the end of another valve is brought to the abdominal surface to form a small stoma. The pouch is emptied by inserting a flexible silicone catheter into the stoma 4-8 times a day.

Indiana Pouch: constructed using segments of both small and large intestine. Stomas for these pouches are frequently placed in the belly button, and catheterizing is usually required every 4-6 hours.

Orthotopic Neobladder: an internal pouch that can actually be reconnected to the urethra to provide near-normal urination for men and women who meet special criteria.

      
CONTINENT URINARY RESERVOIR



















      
Procedure
The bladder is removed or bypassed. An internal reservoir is constructed from a segment of the small or large intestine and the ureters are implanted in a way to prevent reflux (back-up) of urine to the kidneys. A valve to retain urine is made within the reservoir.

Advantages
• A small patch is worn over the stoma. A pouching system is not needed.
• No back up of urine into the kidneys.

Disadvantages
• You must intubate (insert tube through the stoma into pouch) to empty every 4-6 hours.
• Potential urinary leakage.
• The long-term results are not 
known.
• Chance of pouchitis (inflammation 
of the reservoir) which requires periodic irrigations and possible medication.



      NEOBLADDER






















Procedure
The bladder is removed or bypassed. A urinary reservoir is made out of bowel and is attached to the urethra to allow voiding by the normal route. The patient voids by relaxing the urinary sphincter while contracting the abdominal muscles.

Advantages
• Urinary continence.
• Normal urination route.
• No external collection pouch.

Disadvantages
• Possible nocturnal leakage.
• Possible need of clean intermittent self catheterization.
• The long-term results are not known.
• Chance of pouchitis (inflammation of the reservoir).


For more information on Urinary Diversions, or to see if you may be a candidate for one of these types of surgeries, please visit www.ostomy.org