There are many people who need to have their large intestine removed to cure a disease or prevent cancer, but who refuse because of their fear of having to wear an ileostomy bag (external appliance). There are many people who have undergone the surgery and have a poor quality of life because of their ileostomy. The diagnosis of "malfunctioning Brooke ileostomy" represents people who have either mechanical problems and/or emotional or psychological difficulty adjusting to life with an external appliance type of ileostomy. Mechanical problems include episodes of leaking and skin irritation, dislodgement of the appliance with physical activity or sweating, stricture of the opening, retraction of the stoma, and parastomal hernia. There are also people who have had an ileoanal J-pouch (restorative proctocolectomy) procedure with a poor outcome.

For all of you, there is another option other than "living with your problem".

People who have had their colon and rectum removed and are living with a conventional ileostomy, and who are in overall good health, can be considered for surgery to convert their ileostomy to a Continent Ileostomy. (For 20 years I have been performing the BCIR or Barnett Continent Intestinal Reservoir, a modification of the Kock Pouch continent ileostomy.) This means that while there will still be a stoma, there will be NO need to wear an external appliance or bag. This is the only alternative that comes close to actually "reversing" the ileostomy. Until the day that transplantation of the large intestine is possible (many, many years away if at all, unlike "solid organ" transplants which can be quite successful such as heart, kidney, liver), there will need to be a way to evacuate waste which means having some type of ileostomy stoma.

If you have had an ileoanal J-pouch operation with a poor outcome due to excessive stool frequency, incontince and or pain, and are in overall good health, you can be considered to undergo takedown of the failed J-pouch and creation of a Continent Ileostomy. Usually there is no need to have a conventional ileostomy with external bag just because the J-pouch operation was not successful. In fact, 50% of the time the existing J-pouch tissue can be used to create the BCIR because often the problem with a failed J-pouch is not the pouch itself but the connection with the anus or the anal sphincter mechanism. This preserves intestinal length.

Some people who need to have their colon and rectum removed may be candidates to have this done and at the same operation undergo creation of the BCIR continent ileostomy. This one-stage operation is for people in stable health and living with their Ulcerative Colitis or Familial Polyposis without being on immunosuppressant medications or high-dose steroids. Candidates for the one-stage approach must also be in good nutritional condition.

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