Proctocolectomy with the Kock Pouch

Abstract

The Kock Pouch was developed by Professor Nils Kock in Göteborg, Sweden, in 1969. Professor Kock had been working with a continent urinary pouch in cats for approximately 7 years prior to first doing a continent ileostomy in humans. Initially, and during the early 1970s, multiple authors had reported on the outcome of patients undergoing a Kock pouch procedure. The indications at that time were specifically for patients not wishing to have a conventional ileostomy, as this was one alternative to total proctocolectomy and ileostomy. It provided the patient with a mechanism for continence, and overcame a significant number of psychosocial problems related to a conventional ileostomy. However, the procedure itself was, and still is, a complex one, with numerous complications. In fact, initially, the revision rate due to leakage from the continent ileostomy was reported in the 50% range. Initially, the outlet valve from the Kock Pouch was brought out obliquely through the rectus muscles in order to provide a mechanism of continence: in the early 1970s the “nipple” valve was introduced for the same purpose. However, there were problems with stabilization and sliding of the valve which required reoperations.