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Reduced Hospital Stay in BCIR Ileostomy Surgery

With recent advances in the area of BCIR ileostomy Surgery, the Continent Ostomy Program of Olympia Medical Center in Los Angeles, CA under the direction of Dr. Don J. Schiller,MD,FACS, has reduced the hospital stay associated with BCIR ileostomy surgery from 21 days to 14 days.

Dr. William O. Barnett (deceased) is the Surgeon who created the Barnett Continent Intestinal Reservoir or BCIR. The Barnett pouch is a major modification of the Koch Pouch continent ileostomy. A conventional ileostomy requires wearing an external appliance or bag to collect the intestinal waste which flows continuously day and night. The continent ileostomy is very different. There is still a stoma where the intestine is connected to the skin of the lower abdomen, but no intestinal waste or gas comes out of the stoma. Several times daily the pouch is evacuated by sitting on a toilet and inserting a catheter (tube) through the stoma into the internal pouch or reservoir. The waste drains through the catheter automatically. No external bag is worn, only a small patch or covering over the stoma itself which is situated just above the pubic hair line, much lower than a conventional ileostomy.

Dr. Barnett'ss version was developed over the 1980s. His method of care after this major surgery included routine use of intravenous nutrition (known as TPN or total parenteral nutrition; see http://www.ileostomy-surgery.com/Ileostomy_Diet_Nutrition_and_Peristalsis.html for more information) and the use of an indwelling catheter left in the pouch after surgery for continuous decompression for 17 days. On the 18th post-operative day the catheter was removed and the patients then spent 3 more days in the hospital to be educated by the Nursing staff in how to intubate or self-catheterize the pouch. That added up to 21 days in the hospital. For more information on BCIR and ileostomy history, see http://www.ileostomy-surgery.com/History_of_BCIR-Barnett_Continent_Intestinal_Reservoir.html.

Times have changed. Instead of creating the intestinal pouch by hand-suturing, a combination of surgical stapling devices and suturing are now used at the Continent Ostomy Program of Olympia Medical Center in Los Angeles, CA under the direction of Dr. Don J. Schiller,MD,FACS, a well regarded surgeon in the community for many years. Dr. Schiller has found that this technique of pouch formation to create the BCIR allows for a greater initial capacity than with the hand-sutured technique used by Dr. Barnett in the past and by some surgeons currently. The greater volume or capacity, the sooner the continent ileostomy catheter can safely be removed after surgery, decreasing hospital stays significantly. Currently, patients have their ileostomy catheter removed on the 12th day after surgery, and require only 2 days additional for learning how to take care of their BCIR pouch. Dr. Schiller has not had any patients in the past decade who have required more than 2 days of nursing education. In addition, the routine use of TPN has been changed to selective use. Most people in good nutritional condition at the time of surgery do not need TPN and can avoid difficulties created by the TPN and the frequent blood test monitoring that is required.

The end result of this evolution in surgical technique is a much shorter hospital stay. Instead of Dr. Barnett'ss original time-line of 21 days (1 day prior to surgery, 17 days with the catheter to drainage, and 3 days of teaching), now patients stay 14 days including 2 days of teaching as a third day has been shown to be unnecessary (see http://www.ileostomy-surgery.com/Post_Operative_Ileostomy_Care.html). At the time of discharge patients can expect to be eating normally, to be comfortable being up and around, and to be confident and capable of managing their new internal ileostomy pouch for the rest of their lives. They will be followed during the first 6 months after surgery by Dr. Schiller personally with scheduled office visits or, for out-of-town patients, by scheduled telephone appointments. Dr. Schiller is committed to being available to his patients at any time should questions or concerns arise, both during the first 6 months after surgery as well as at any time in the future. He also will communicate with local physicians should other medical or surgical issues arise with a patient.

Further ileostomy surgery information is available at: http://ileostomy-surgery.com/Common_Conditions_Leading_to_Ileostomy_Surgery.html

About the Ileostomy Surgery Center:

The Ileostomy Surgery Center is the leading surgical center west of the Mississippi for the BCIR procedure (Barnett Continent Intestinal Reservoir). Headed by Don J. Schiller, MD, FACS, the center has been at the forefront of developments in ileostomy Surgery.

Contact:

The Ileostomy Surgery Center

9808 Venice Blvd, Suite 603

Culver City, CA 90232

Phone: (310) 204-4565

Fax: (310) 204-4566

http://www.ileostomy-surgery.com

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