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Reply to "J pouch vs BCIR or K pouch"

Graeme, 

When they made the k pouch back in the 1960's it was to replace the outside bags but they had not considered making it with the natural exit...once the k pouch was up and running it was discovered that the one-way valve was both its strong point and weak point. 

They then decided to try using the natural exit and it worked fine so it became an easier and more popular solution...they did not need to make the tricky valve that had the most need for repairs.

In the short term, other than fistulas and pouchitis there were very few problems (still today). As I said, it is a learning curve for your body...it needs to understand that the colon is gone and that your pouch needs to learn new tricks like absorbing fluids (which is usually the colon's job) and holding large quantities of stuff. 

They almost stopped making K pouches after that except that there were a few patients like me who did not have a functional 'downstairs' or had rectal cancer that put-pay to the idea of a j pouch if the cuff was removed or if someone who already had an end-ileo and had been closed up down there.

Fewer and fewer surgeons learned the technique and the opportunities for doing more or training new ones because less frequent. 

Then they created the BCIR which was a modified version of the K pouch with a living collar around the valve and that became more or less the 'gold standard' for most people.

So, there you have it, a bit of history and an explanation. 

I hope that this helps you

Sharon

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