The New BCIR - A Major Progress Toward Shorter Hospital Stays

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Olympia Medical Center in Los Angeles is doing a new procedure called The New BCIR or Barnett Continent Intestinal Reservoir which will help with shorter hospital stays for patients

The continent ileostomy also known as the BCIR or Barnett Continent Intestinal Reservoir was devised by the late Dr. William O. Barnett as an evolution of the Koch Pouch. The original technique of Dr Koch (a surgeon in Sweden in the 1960s and 70s) had a very high failure rate. The main problem was slipping of the continence mechanism - a nipple valve made of the patient's own intestine. When the valve slips out of position, the patient will have leakage of waste and gas out of the stoma, and will also have great difficulty inserting their drainage catheter. The BCIR modification of the Koch procedure included an intestinal collar which decreases the incidence of valve slippage.

Dr. Barnett created his pouch by hand sewing it, and he kept patients in the hospital for 3 full weeks. 17 days after the operation, he would take out the ileostomy catheter placed during surgery, and would then keep patients in the hospital for 3 additional days of education and instruction by the nursing staff about living with the BCIR. Discharge was on the 21st day of hospital stay.

Times have changed. Dr. Don J. Schiller of Los Angeles, CA and Medical Director of Olympia Medical Center's Continent Ostomy Center started performing the BCIR in 1989. In 1998 he began to create the internal intestinal pouch using modern, high-tech surgical stapling devices. This creates a pouch which immediately has a much greater capacity than a hand-sewn pouch which requires infolding of the intestinal wall. A large pouch means much less pressure is created inside as it fills. This change has shortened the hospital stay by a full week. At the end of the surgery, a catheter is still placed into the stoma and connected to a drainage system to prevent any distention of the pouch during the early healing phase. This catheter is removed on the 12th day after surgery and the patient starts to learn care and use of the pouch with the nursing staff. Only 2 days are needed as Dr. Schiller has never had a patient who was not confident, comfortable and skilled after this 2 day period. A third day of instruction and supervision while still in the hospital would be used if needed, but no patient whether age 16 or 61 has needed more than 2 days. A shorter length of stay has resulted in no change in outcomes. It does enable people to return home a week earlier.

At Olympia Medical Center's Continent Ostomy Center all rooms are private rooms. In addition, the Center cares for many Ostomy patients who don't have a BCIR but come for surgical procedures including stoma revisions, repair of stoma hernias, repair of incisional and other hernias.

Located in the heart of West Los Angeles, Olympia Medical Center has been providing medical care to its community since 1948. Services at the 204-bed acute care hospital include comprehensive inpatient and outpatient services, and a 24-hour emergency room. Specialty programs include the California Digestive Diseases Institute, Take Off, a Medical and Surgical Weight Control Program, the Los Angeles Center for Spine Care and Research, the Southern California Sports Medicine Institute, the Center for Wound Management and Hyperbaric Medicine, the Continent Ostomy Center, the Center for Geriatric Health and the Memory Institute.

At Olympia Medical Center, we are dedicated to clinical excellence, delivering health care services in a patient-centered, community-focused environment. We not only try to meet your expectations--but to exceed them as well. Quality and compassionate careā€¦it's our commitment to you.

Olympia Medical Center is fully accredited by the Joint Commission on Accreditation of Healthcare Organizations, the nation's oldest and largest hospital accreditation agency. To learn more about Olympia Medical Center visit http://www.olympiamedicalcenter.com
and http://www.ileostomy-surgery.com

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ANGELA GIACOBBE
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