The Difference Between BCIR And The Kock Pouch

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If you have a severe bowel disease like Crohn’s or ulcerative colitis, then the doctor might be discussing surgical options with you such as the Kock Pouch or Barnett Continent Intestinal Reservoir (BCIR).

Understanding the difference will help as you prepare for your surgery.

What is a Kock Pouch?

The Kock Pouch is an alternative to a traditional ileostomy that requires no external bag to collect waste material. It was developed in 1969 by Dr. Nils Kock. During this surgery, the doctor modifies the terminal ileum (the last part of the small intestine) to create a pouch. A valve mechanism attached to the exit of the terminal ileum prevents leakage of stool and gas from escaping. Patients insert a catheter into the pouch to drain it through a small stoma opening.

The internal pouch eliminates many of the complications and side effects of an ileostomy. There are no skin irritations from adhesives, for example, or the smell associated with an external bag.

What is the Barnett Continent Intestinal Reservoir?

The Barnett Continent Intestinal Reservoir, or BCIR, is a procedure developed by Dr. William Barnett. Like the Kock Pouch, a BCIR is a surgically-created pouch that collects waste material from the intestines. You drain the pouch several times a day using a catheter inserted through a small opening in the skin. This is a modified version of the internal pouch created by Dr. Nils Kock.

Both the Kock Pouch and BCIR store stool intra-abdominally and allow you to drain it through a catheter. The older Kock design can cause some complications, however. The original procedure can lead to valve slippage that makes draining the pouch difficult. After a few years, a fistula, or abnormal connection, can develop in the valve.

The Barnett Continent Intestinal Reservoir helps to reduce these problems. An intestinal collar prevents valve slipping to make drainage easier. The collar is made out of the small intestine to improve stability.

BCIR vs. Traditional Ileostomy

A BCIR is different from the traditional, or Brooke ileostomy, which requires the patient to live with an external bag. With the Brooke design, the surgeon brings the end of the small intestine to the skin surface and creates an opening. Waste material passes through this opening into a bag attached to the outside of the stomach just above the groin.

Choosing the Right Design

Ultimately, the surgeon will choose the best procedure for you based on your health and other factors such as your age and weight. If an internal pouch is part of your care plan, odds are it will be a BCIR. The Barnett Continent Intestinal Reservoir is an upgrade over the older pouch design, but there are some contraindications for this procedure. If you have active Crohn’s disease that affects the small intestine, for example, a BCIR is not the right choice for you.