Can anyone offer advice between a K pouch and a BCIR? How does someone make this choice?

What about surgeons? I live in Colorado, but my parents live in Cleveland and I had a stoma revision done by Dr. Lavery at the Cleveland Clinic a few years ago, so that would be a convenient option. I am not opposed to traveling elsewhere, though, for a better outcome. Thanks.

Here's the list of surgeons that we know of (it's in this Korner, too..)

http://j-pouch.org/eve/forums/...531006091/m/23110816

How I look at it is that if the Cleveland Clinic (and Dr Launer and team who trained with Dr Kock, too) only do Kock pouches, they must have a reason. CC and Scripps are major hospitals.

But, there are alot of success stories with BCIRs. The difference is the valve (living collar) but it has been known to fail, too, and need to be revised.

Janice, thanks for the info. I see that you've had a few valve repairs. I'm wondering what that entails. Specifically, I live in Colorado and will likely have this done at the Cleveland Clinic. if I need a valve repair, do I need to immediately jump on a plane to Cleveland? Or can I live with it for a week or two? What would that be like? Would I be leaking all over? Thanks so much.

Hi Steve, I had my valve repairs in the early 80ies. I did not leak gas or feces (it remained continent), but what happened is that it kinked as I sat to empty (it ended up being a bit too short) and I couldn't get the catheter in without a huge struggle. I used lay down to put my little pinkie into the stoma to help dialate it but was a hassle at work doing this so had it fixed.

When it needed a repair, I just kept the catheter taped in with a plug at the end (not attached to a leg beg) and waited for my hmo ins approval -usually always within 2 weeks. My surgeon was local, but you could certainly plan to hop on a plane and travel this way.

It was open surgery - and after I had to keep the cath taped in for 21 days again to let it heal so it wasn't an out patient type thing. But, I am not sure how they do it now...that was in the 80ies.

Link from the BCIR site that explains the difference. The big difference is that the Kock uses mesh as a collar and the BCIR uses your own tissue:

http://bcirhistory.com/#differencesbetweentheKoch

This link discusses the Kock pouch and also has a list of surgeons (updated July 2009). It indicates improvements over the years:

http://alumnus.caltech.edu/~pls/kock/

Some surgeons outside of BCIR "centers" also use a modified BCIR technique in forming their continent ileostomies.

Jan

Perhaps the sites Jan has provided are either provided by the BCIR people (the first one which may not be completely objective) or not completely up-to-date (I read the second one years ago before my surgery in 2003).

Jan knows much more technical information than I do but I do have a k-pouch created by Dr. Fazio. It's my understanding that rather than using mesh, Dr. Fazio tacks down the valve. I remember being scoped by him in Cleveland (about a year after my surgery there) while a visiting colorectal surgeon observed. I saw on the monitor sort of a white string attached to the valve. The observing surgeon asked, "Is that an adhesion?" and Dr. Fazio replied, "No" and something about the string-like piece was tacking down the valve.

I know the BCIR procedure has its enthusiastic fans, but I had a troubling appointment with such a surgeon before I decided to proceed with surgery in Cleveland. You can private message me for details.

Yeah, you are right. The first link was from the BCIR site (the only place I could find a description of the difference), and the second is not current. But, again, it was what I could find. I wish I could find something more current, but I guess they just are not writing articles about it.

They are always updating technique on complex surgeries, and it is probably why they are doing the modified BCIR in many places. I just could not find any descriptions. I know the mesh can be problematic because of the scar tissue buildup. I know there was some controversy in the past regarding the commercialization of the BCIR, but in recent years that seems to have simmered down.

Jan

K or a BCIR
Well honestly I can't be of much help My daughter has a BCIR and had her last valve revision in CA as my brother n law was in Fl having a K-pouch at the exact same time.
One year later both of them have slipped valves.
She was 17 and he was 46

Some prefer the BCIR version of the continent pouch. The BCIR has what is called a 'living collar' that supports the base of the valve.
This 'living collar' is made of a piece of the small intestine and as it fills up with fecal matter, it supports the base of the valve and offers more support to the valve and suspposedly there is less valve slippage.

I am not too clear on most of it all but I believe that Dr. C gave me a living collar on my last pouch/valve revision due to repeated valve slippage...he wrapped a piece of intestine around the neck of the valve..I've seen it in the last scope..neat! It supports the valve and prevents slipping/twisting...so I guess some surgeons do both!
Sharon

If the same surgeon has failed 3 times - it may be worth a consultation with another solid surgeon. They may be able to find the problem and share the information with your existing surgeon or able to redo the valve as well.

I'm all for loyalty to a surgeon, but I also think 2nd opinions are well worth it.