Barnett continent intestinal reservoir. Multicenter experience with an alternative to the Brooke ileostomy

Since 1988, surgeons at five hospitals have been performing the Barnett continent intestinal reservoir (BCIR). The BCIR includes modifications to the original Kock pouch, designed to reduce the incidence of valve slippage and fistula formation. Principle modifications include an intestinal collar, an isoperistaltic valve, and a lateral pouch design. This unique collaborative study includes 510 ulcerative colitis or familial polyposis patients, with a follow-up time from one to five years postoperatively. Ninety-two percent still have functioning reservoirs. Six and one-half percent have had their pouches removed and replaced with conventional Brooke ileostomies. Reoperation rate for major pouch-related complications (other than pouch removal) was 12.8 percent. These complications included slipped valve (6.3 percent), valve fistulas (4.5 percent), and pouch fistulas (6.3 percent). Several questions were administered to patients whose responses revealed a significant improvement in general quality of life, state of mind, and overall health. The BCIR represents a successful alternative to patients with a conventional Brooke ileostomy or those who are not candidates for the ileal pouch-anal anastomosis.