Don't Forget about the K-Pouch!

Abstract

The continent ileostomy (CI) was popularized by Nils Kock as a means to provide fecal continence to patients, most commonly in those with ulcerative colitis, after proctocolectomy. Although the ileal pouch-anal anastomosis (IPAA) now represents the most common method to restore continence after total proctocolectomy, CI remains a suitable option for highly selected patients who are not candidates for IPAA or have uncorrectable IPAA dysfunction but still desire fecal continence. The CI has exhibited a fascinating and marked evolution over the past several decades, from the advent of the nipple-valve to a distinct pouch design, giving the so-inclined and so-trained colorectal surgeon a technique that provides the unique patient with another option to restore continence. The CI continues to offer a means for appropriately selected patients to achieve the highest possible quality of life (QOL) and functional status after total proctocolectomy.

Keywords

continent ileostomy - Kock pouch - ulcerative colitis

Publication History

Article published online:
29 November 2022

• References

• 1 Nessar G, Wu JS. Evolution of continent ileostomy. World J Gastroenterol 2012; 18 (27) 3479-3482
• 2 Qayed E, Shahnavaz N. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Review and Assessment. Philadelphia: Saunders; 2021
• 3 Kock NG. Intra-abdominal “reservoir” in patients with permanent ileostomy. Preliminary observations on a procedure resulting in fecal “continence” in five ileostomy patients. Arch Surg 1969; 99 (02) 223-231
• 4 Ojerskog B, Hällström T, Kock NG, Myrvold HE. Quality of life in ileostomy patients before and after conversion to the continent ileostomy. Int J Colorectal Dis 1988; 3 (03) 166-170
• 5 Säuberli H, Geroulanos S, Hahnloser P, Schauwecker H, Kock NG. Studies of the dynamics of the “nipple valve” in dogs with continent colostomies. Dis Colon Rectum 1974; 17 (06) 735-740
• 6 Kock NG. Intussuscepted ileal nipple valve–early experience. Scand J Urol Nephrol Suppl 1992; 142: 59-63
• 7 Steichen FM, Loubeau JM, Stremple JF. The continent ileal reservoir. Surg Rounds 1978; 10-18
• 8 Fazio VW, Tjandra JJ. Technique for nipple valve fixation to prevent valve slippage in continent ileostomy. Dis Colon Rectum 1992; 35 (12) 1177-1179
• 9 Thompson JS, Williams SM. Fistula following continent ileostomy. Dis Colon Rectum 1984; 27 (03) 193-195
• 10 Kaufman Z, Engelberg M, Zager M. Fecal fistula: a late complication of Marlex mesh repair. Dis Colon Rectum 1981; 24 (07) 543-544
• 11 Klingler PJ, Neuhauser B, Peer R, Klingler CH, Bodner E. Nipple complication caused by a mesenteric GORE-TEX sling reinforcement in a Kock ileal reservoir: report of a case. Dis Colon Rectum 2001; 44 (01) 128-130
• 12 Ecker KW, Hildebrandt U, Haberer M, Feifel G. Biomechanical stabilization of the nipple valve in continent ileostomy. Br J Surg 1996; 83 (11) 1582-1585
• 13 Barnett WO. Continent Ileostomy. South Med J 1983; 76 (05) 583-586
• 14 Barnett WO. Current experiences with the continent intestinal reservoir. Surg Gynecol Obstet 1989; 168 (01) 1-5
• 15 Kaiser AM, Stein JP, Beart Jr RW. T-pouch: a new valve design for a continent ileostomy. Dis Colon Rectum 2002; 45 (03) 411-415
• 16 Kaiser AM. T-pouch: results of the first 10 years with a nonintussuscepting continent ileostomy. Dis Colon Rectum 2012; 55 (02) 155-162
• 17 Castillo E, Thomassie LM, Whitlow CB, Margolin DA, Malcolm J, Beck DE. Continent ileostomy: current experience. Dis Colon Rectum 2005; 48 (06) 1263-1268
• 18 Ecker NKJ, Möslein G, Ecker KW. Continent ileostomy: short- and long-term outcomes of a forgotten procedure. BJS Open 2021; 5 (05) zrab095
• 19 Dozois RR, Kelly KA, Ilstrup D, Beart Jr RW, Beahrs OH. Factors affecting revision rate after continent ileostomy. Arch Surg 1981; 116 (05) 610-613
• 20 Wasmuth HH, Svinsås M, Tranø G. et al. Surgical load and long-term outcome for patients with Kock continent ileostomy. Colorectal Dis 2007; 9 (08) 713-717
• 21 Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ 1978; 2 (6130): 85-88
• 22 Utsunomiya J, Iwama T, Imajo M. et al. Total colectomy, mucosal proctectomy, and ileoanal anastomosis. Dis Colon Rectum 1980; 23 (07) 459-466
• 23 Kock NG. Continent ileostomy. Prog Surg 1973; 12: 180-201
• 24 Gelernt IM, Bauer JJ, Kreel I. The reservoir ileostomy: early experience with 54 patients. Ann Surg 1977; 185 (02) 179-184
• 25 Bokey L, Fazio VW. The mesenteric sling technique: new method of constructing an intestinal nipple valve for the continent ileostomy. Cleve Clin Q 1978; 45 (02) 231-236
• 26 Mori Y, Shima H, Ikoma F. A seromuscular stripping method to create a nipple valve without metal stapling for continent urinary reservoir. J Urol 1991; 145 (03) 492-494
• 27 Fazio VW, Church JM. Complications and function of the continent ileostomy at the Cleveland Clinic. World J Surg 1988; 12 (02) 148-154
• 28 Schrock TR. Complications of continent ileostomy. Am J Surg 1979; 138 (01) 162-169
• 29 Svaninger G, Nordgren S, Oresland T, Hultén L. Incidence and characteristics of pouchitis in the Kock continent ileostomy and the pelvic pouch. Scand J Gastroenterol 1993; 28 (08) 695-700
• 30 Beck DE. Continent ileostomy: current status. Clin Colon Rectal Surg 2008; 21 (01) 62-70
• 31 Handelsman JC, Gottlieb LM, Hamilton SR. Crohn's disease as a contraindication to Kock pouch (continent ileostomy). Dis Colon Rectum 1993; 36 (09) 840-843
• 32 Aytac E, Dietz DW, Ashburn J, Remzi FH. Long-term outcomes after continent ileostomy creation in patients with Crohn's disease. Dis Colon Rectum 2017; 60 (05) 508-513
• 33 Tajika M, Niwa Y, Bhatia V, Tanaka T, Ishihara M, Yamao K. Risk of ileal pouch neoplasms in patients with familial adenomatous polyposis. World J Gastroenterol 2013; 19 (40) 6774-6783
• 34 Mullen P, Behrens D, Chalmers T. et al. Barnett continent intestinal reservoir. Multicenter experience with an alternative to the Brooke ileostomy. Dis Colon Rectum 1995; 38 (06) 573-582
• 35 Ecker KW, Haberer M, Feifel G. Conversion of the failing ileoanal pouch to reservoir-ileostomy rather than to ileostomy alone. Dis Colon Rectum 1996; 39 (09) 977-980
• 36 Ecker KW, Dinh C, Ecker NKJ, Möslein G. Conversion of ileo-pouch anal anastomosis to continent ileostomy: strategic surgical considerations and outcome. Colorectal Dis 2022; 24 (05) 631-638
• 37 Ecker KW, Dinh C, Ecker NKJ. Development of a systematic approach to conversion of the ileoanal pouch into continent ileostomy. Tech Coloproctol 2021; 25 (11) 1233-1242
• 38 Wasmuth HH, Tranø G, Wibe A, Endreseth BH, Rydning A, Myrvold HE. Failed pelvic pouch substituted by continent ileostomy. Colorectal Dis 2010; 12 (7 Online): e109-e113
• 39 Börjesson L, Oresland T, Hultén L. The failed pelvic pouch: conversion to a continent ileostomy. Tech Coloproctol 2004; 8 (02) 102-105
• 40 Aytac E, Dietz DW, Ashburn J, Remzi FH. Is conversion of a failed IPAA to a continent ileostomy a risk factor for long-term failure?. Dis Colon Rectum 2019; 62 (02) 217-222
• 41 Lian L, Fazio VW, Remzi FH, Shen B, Dietz D, Kiran RP. Outcomes for patients undergoing continent ileostomy after a failed ileal pouch-anal anastomosis. Dis Colon Rectum 2009; 52 (08) 1409-1414 , discussion 4414–4416
• 42 Lepistö AH, Järvinen HJ. Durability of Kock continent ileostomy. Dis Colon Rectum 2003; 46 (07) 925-928
• 43 Nessar G, Fazio VW, Tekkis P. et al. Long-term outcome and quality of life after continent ileostomy. Dis Colon Rectum 2006; 49 (03) 336-344
• 44 Bloom RJ, Larsen CP, Watt R, Oberhelman Jr HA. A reappraisal of the Kock continent ileostomy in patients with Crohn's disease. Surg Gynecol Obstet 1986; 162 (02) 105-108
• 45 Deputy M, Worley G, Patel K. et al. Long-term outcome and quality of life after continent ileostomy for ulcerative colitis: a systematic review. Colorectal Dis 2021; 23 (09) 2286-2299
• 46 Risto A, Hallböök O, Andersson P, Sjödahl R, Myrelid P. Long-term follow-up, patient satisfaction, and quality of life for patients with Kock's continent ileostomy. Dis Colon Rectum 2021; 64 (04) 420-428
• 47 Gerber A, Apt MK, Craig PH. The improved quality of life with the Kock continent ileostomy. J Clin Gastroenterol 1984; 6 (06) 513-517
• 48 Denoya PI, Schluender SJ, Bub DS, Gorfine SR, Bauer JJ. Delayed Kock pouch nipple valve failure: is revision indicated?. Dis Colon Rectum 2008; 51 (10) 1544-1547
• 49 Ecker KW, Tönsmann M, Ecker NKJ, Möslein G. Salvage surgery for continent ileostomies (CI) after a first successful revision: more long-term blame on the reservoir than the nipple valve. Int J Colorectal Dis 2022; 37 (03) 553-561
• 50 Litle VR, Barbour S, Schrock TR, Welton ML. The continent ileostomy: long-term durability and patient satisfaction. J Gastrointest Surg 1999; 3 (06) 625-632