I am new here so trying to find views and data on the relative risks, complications, outcomes, and quality of life etc that would lead people to choose one or the other.

On the face of it I would expect people to opt for a BCIR as there is no external bag and,  seems to have way more control over when needing to toilet etc.

Perhaps the choice is more to do with what procedure is available near you ?

I would welcome comments

Original Post

Welcome to the group.  I have had both a J pouch and a BCIR and can say that there a number of factors to consider regarding which procedure is best suited for your situation. You are on the right track to obtain information on the options that are available.  Performing research on the internet was the topic of a presentation I made at a national conference and wrote an article entitled, “Researching My Options” that appeared in UOAA’s magazine, The Phoenix.  This article is accessible in its entirety in the Quality Life Association’s website (www.qla-ostomy.org) under the “Ostomy Options and Education” tab.  This website also has information and videos about continent ostomies.

While closeness to your home of a surgeon who does one of these procedures is a consideration, a more important consideration is to select a surgeon who has done many of the procedure that you believe is best for you. Please feel free to send me a Private Message with questions you have or your contact information if you favor a conversation.

Bill

Hi Bill

Many thanks for that. I have read your article. I am researching this to assist a family member who lives in Melbourne Australia where I understand there are 2 surgeons who have trained in the US at Cleveland Clinic. 

As far as I know the BCIR is not often done in Aussi

I was thinking that the more high volume surgeons in USA might be better options but the issue of post of care arises around that so it is probably not a great option.  Again many thanks for your reply

Graeme

 

 

the k pouch was the predecessor to the j, with the j considered an improvement/advanced resolution .  i started with the j, in 1999, but it failed due to pouchitis that was not responsive to treatment, despite many types and woefully too long term.  like others with js, which failed for one reason or another, i faced a permanent ileostomy.  most gi surgeons only suggest the external bag as so few are familiar and capable of creating the k.  for example, here in boston ma--a known medical center--there are no docs who even suggested it let alone would do the surgery!  i became informed through this website (thank you my k korner family) and had the surgery at cleveland clinic in 2015. 

i'm don't recall the j's failure rate, perhaps 10%?  please can others reading this chime in?  don't want to frighten you!!   bric and ks also have a failure rate.  as i understand there are new drugs for uc.  are they not working?

finally, to answer your question!!  the times when the j was healthy were better than the k.  but also, one must face reality.  in hindsight, my quality of life is fine, just different, from when i had a colon and functioned normally.

stay strong and healthy.  jan

Graeme,

I have had my k pouch for 41 yrs so I am one of the 'oldbies'.

I have had my ups and downs, my revisions and complications. I have had problems, especially living here in France. But I have never, every regretted my K pouch.

That said, the j pouch did not exist when I had mine done in 1979. I would not have been a candidate if it had, either. 

I had no sphincter at all and had 2 surgeries to try to build me one (Gracillis muscle flap surgeries...Brutal and both failures).

So for me it was either an outside appliance or a K pouch. 

I made the right choice. 

But I am someone who is very prudent too. If your sphincter is fully functional, if you have strong pelvic muscles or are willing to do the work to maintain them then why would you want to close up the bottom? 

A Jpouch is more natural, requires less outside gear and you can eat most anything after about a year (that is the learning curve for the average body).

So, in spite of understanding the desire to have 1 surgery and be on your way with your life, I would strongly suggest that you start with a J pouch and see how that goes. Most people do wonderfully (you mostly hear from those who are having troubles on forums and sites) with their J pouches and do not often have to think about them. Once the learning curve past and the mastery of your new plumbing acquired, you should be quite happy.

Then again, there is always the question of proximity to your surgeon...not a negligible pre-requisite. I have to travel to North America to get help in case of an emergency. And it can be very frightening when you are in trouble.

So, please think carefully, do your research and be at peace with your decision.

Sharon

Hi Sharon

Thanks for that.  So I think I am hearing that a reasonably well working J is perhaps preferable to a well working BCIR. And that if the j fails then one could then try the BCIR.  I guess that makes sense, and why the j is more common.

 

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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