Is the Kock pouch still a viable option?
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Despite the success the Kock pouch has had in providing continence for many patients requiring ileostomy, the procedure has failed to gain widespread acceptance as a viable option for patients requiring proctocolectomy. The reasons for this include the complexity of the operation, the initial reports of high complication rates associated with the Kock pouch and the advent of the ileo-anal reservoir. However, technical developments and experience have led to a progressive decline in both early and late complications. Early complications now approximate to those of any other major intra-abdominal bowel operation. The incidence of late complications requiring revisional surgery has decreased from 54% to 9.3%–25%. Operative mortality, originally reported as high as 4.3%, is now almost zero. Although the ileo-anal reservoir is the preferred alternative to conventional ileostomy, it is not suited to all patients. The current status of the continent ileostomy and its role in patients with inflammatory bowel disease is reviewed. Any surgeon interested in providing a continent option for the patient requiring proctocolectomy should be aware of the significant improvement in the operative results of the conztinent ileostomy using contemporary surgical techniques.
The answer to the question “Is the Kock pouch still a viable option?” is therefore unequivocally yes. Recent advances in surgical technique and postoperative care have decreased the incidence of complications to acceptable levels when performed by experienced surgeons. Patients unsuited to restorative proctocolectomy and those 5–15% of patients who have failed after restorative proctocolectomy may desire a continent option. The Kock pouch still offers a valuable alternative to conventional ileostomy in these patients.
KeywordsInflammatory Bowel Disease Operative Result Late Complication Operative Mortality Viable Option
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