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Video

Session: Ongoing Videos

VM53 - The Stapled Barnett Continent Intestinal Reservoir (BCIR) Technique

ONGOING VIDEOS
Location: San Diego Convention Center, ASCRS Connect Lounge, Hall B1/B2, Ground Level

    Video Presentation(s)

  • Jennifer L. Miller-Ocuin, MD

    Colorectal Surgeon
    NA
    Cleveland Heights, Ohio, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • ER

    Ernest C. Rehnke, MD FACS

    Physician General Surgeon
    Retired
    St Petersburg, Florida, United States

    Disclosure information not submitted.

  • AT

    Ananya Tawde, MD

    General Surgery Resident
    Case Western Reserve University
    Cleveland, Ohio, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Jean H. Ashburn, MD

    Associate Professor of Surgery
    Atrium Health Wake Forest Baptist
    Wake Forest Baptist Health
    Winston-Salem, North Carolina, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Jennifer L. Miller-Ocuin, MD: This individual has no financial relationships with ineligible companies.
Jean H. Ashburn, MD: This individual has no relevant relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Continent ileostomy (CI) provides the ability to defer bowel movements in patients requiring surgical removal of the diseased colorectum as an alternative to a conventional end ileostomy. William O. Barnett pioneered the Barnett Continent Intestinal Reservoir (BCIR) in 1979, around the same time Parks and Nicholls introduced the ileal pouch anal anastomosis (IPAA). IPAA grew in popularity as it offered decreased complexity of construction and potential for decreased procedural morbidity, especially with introduction of the stapled technique.

Methods/Interventions: In this video we will describe the stapled technique for creation of the Barnett continent intestinal reservoir.

Results/Outcomes: The BCIR is created by first measuring the 12 cm living collar. Next two 15 cm limbs are measured to form the pouch body, configured side-to-side. Then the pouch body is created using 2-3 sequential firings of the linear cutting stapler to open the pouch body. A 12 cm length is measured to later create the intussuscepted valve. Then the access segment length is determined (to match abdominal wall thickness) but a standard length of 10 cm is typically sufficient. An EEA stapler is then inserted into the body of the pouch and used to create a stapled circular anastomosis with the afferent limb containing the anvil. The nipple valve is created after denuding the associated mesentery then intussuscepting the loop of intestine. The valve is then fixed with multiple firings of a transverse, non-cutting stapler. The living collar is wrapped around the intersection of the access segment to the pouch body to further stabilize the valve. The access segment is brought through the abdominal wall. The pouch body is secured to the posterior sheath. A drain is placed near the living collar. A catheter is inserted into the pouch and secured. The drainage catheter remains at least 19 days postoperatively. Patients then begin intermittent catheterization at scheduled intervals.

Conclusion/Discussion: The stapled BCIR technique decreases complexity of construction of the continent ileostomy.