The Kock reservoir ileostomy: A review of its development, problems and role in modern surgical practice

Abstract

The Kock continent ileostomy reservoir was designed in an attempt to overcome many of the problems associated with the conventional ileostomy. An account is given of the technical developments of this procedure since its inception. An intussusception valve within the reservoir is necessary for continence. However, valve failure is a common problem and the developments in construction which have helped to overcome this are described. The major complications associated with the continent ileostomy are discussed in detail, and an attempt is made to define its present role in the treatment of inflammatory disease of the colon.

Continent Ileostomy: Current Experience

“…Historic revision rates of continent ileostomies have been high. [5][6][7][8][9][10][11]17 Although technical modifications have decreased the need for revisions, few surgeons perform continent ileostomy procedures, especially after the introduction of the restor- One patient initially diagnosed with ulcerative colitis later found to have Crohn's; one patient was unable to manage the continent pouch in nursing home. ative proctocolectomy (IPAA).…”

“…The construction of the continent pouch is complex and associated with a high rate of reoperations because of a sliding nipple valve or other related problems. [5][6][7][8][9][10][11] Several technical modifications have reduced the nipple valve dysfunctions; however, revision rates remain high. 2,5,[12][13][14][15] The development of the restorative proctocolectomy or ileal pouch-anal anastomosis (IPAA) coupled with the moderate rate of reoperations has substantially decreased the enthusiasm for continent ileostomies.…”

Die kontinente Ileostomie Gegenwärtige Indikationen, Vorgehensweisen und Ergebnisse

“…Bei der anisoperistaltischen Faltung des K-Modells wird die Pouchwand gegen den Widerstand ihres Mesenteriums nach vorn umgeschlagen. Daraus kann eine gewisse Spannung der Vorderwandnaht resultieren, die infolge des gröûeren Radius zur Ventilbasis hin am stärksten wird [2]. Hat man den TA 55 zur Nippelstabilisation verwandt, finden sich exakt in dieser Region die übernä-hungspflichtigen Stanzperforationen des Gerätedorns.…”

Radiologic Evaluation of the Continent (S-Pouch) Ileal Reservoir with Anal Anastomosis

“…Ileorectal anastomosis was not always a satisfactory alternative (1). In the late sixties, KOCK (5, 6) introduced a new surgical procedure for a continent ileostomy (2,3,5,6,10). This was a technically difficult operation, often with postoperative complications, while the patient still suffered the drawback of an ileostomy (17).…”

“…These advanced operations require follow-up investigations in order to identify and treat postoperative complications. Radiologic evaluation proved to be of great value in the development of Kook's continent ileostomy (2,3,10).…”